Medicare Reimbursement for Florescein and Indocyanine-Green Angiography

FA allows the clinician to evaluate a wide variety of retinal conditions, such as proliferative diabetic retinopathy, macular edema, vascular occlusive disease, age related macular degeneration, and ocular tumors, as well as other retinal pathology. Many third party payers publish policies identifying covered indications for testing.

ICG is performed to assess conditions of the choroid. A few Medicare Administrative Contractors (MACs) have published lists of valid diagnoses. While these lists differ slightly from contractor to contractor, they commonly include diseases of the choroid and subretinal anatomy (e.g., SRNVM, serous or hemorrhagic detachment of the RPE, and subretinal hemorrhage). Note that covered diagnoses for ICG angiography may overlap with, but are not the same as, those for fluorescein angiography. Check your local Medicare coverage policy for a detailed list

This FAQ addresses the following:

1. What are fluorescein and indocyanine-green angiography (FA and ICG) performed with the optomap?
2. What are the indications for these tests?
3. Does Medicare cover FA and ICG?
4. What documentation is required in the medical record to support these claims?
5. Is the physician’s presence required during testing?
6. What CPT codes should we use to describe these tests?
7. What does Medicare allow for these tests?
8. Are there restrictions on other codes that may be billed the same day?
9. If coverage is unlikely or uncertain, how should we proceed?

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