92235
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.73
Facility
$41.75
Non-Facility
$41.75
Documentation Required
- Claims must include the documentation and coding required by LCD L34426 and applicable billing/coding guidelines (procedure codes, supporting clinical rationale, and any required authorizations), as this article supplements that LCD.
- The medical record must include the ordering provider's assessment related to the patient's complaint, relevant medical history, results of pertinent tests/procedures, and a signed and dated office visit or operative report.
- Copies of fluorescein and ICG angiograms (photographic or digital) and a written interpretation/report must be retained in the patient's medical record and available upon Medicare request.
- When ICG angiography is performed, the record must document one of the ICG-specific indications (ill-defined/subretinal neovascular membrane on prior FA; RPE not showing membrane on current FA; or subretinal hemorrhage/hemorrhagic RPE).
Key Coverage Criteria
- Coverage for ophthalmic angiography (fluorescein and indocyanine green) is determined by the Local Coverage Determination L34426 and applies when that LCD's clinical criteria are met.
- Fluorescein angiography is covered when the medical record documents medical necessity for the procedure for each eye, including relevant history, physical exam, and results of pertinent diagnostic tests.
- Indocyanine green (ICG) angiography is covered when one or more of the following are documented: (1) ill-defined subretinal neovascular membrane or suspicious membrane on prior fluorescein angiography, (2) retinal pigment epithelium (RPE) does not show subretinal neovascular membrane on current fluorescein angiography, or (3) presence of subretinal hemorrhage or hemorrhagic RPE.
- Diagnostic angiography (fluorescein or ICG) is covered when the claim includes a valid ICD-10-CM diagnosis code that best describes the patient's condition or the symptom prompting the test, and the ordering/referring provider's name and NPI are reported when required.
- An IDTF must be credentialed and approved by Palmetto GBA provider enrollment to bill Medicare for a specific diagnostic procedure or material.
- Additional services and supplies (e.g., radiopharmaceuticals, special contrast agents, medications) are payable to an IDTF when the diagnostic test itself is payable and the supplies are commonly separately reimbursed to a physician in an office setting.
14 Active Policies
L33693 — Peripheral Venous Ultrasound
J09
L37371 — Electroretinography (ERG)
J12
A53252 — Billing and Coding: Independent Diagnostic Testing Facility (IDTF)
J12
L35007 — Vestibular and Audiologic Function Studies
J12
L35434 — Oximetry Services
Related Codes
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