Ophthalmic Angiography (Fluorescein and Indocyanine Green)

Fluorescein angiography (with interpretation) is covered as a medically necessary adjunct for diagnosing and managing chorioretinal vascular disorders (eg, CNV, noninfective vasculitis, AMD), selected inflammatory or neoplastic intraocular conditions, and for diabetic retinopathy evaluation when clinically indicated. Indocyanine green (ICG) is an acceptable adjunct in specific situations (eg, CNV, retinal neovascularization, RPE detachments) but is contraindicated with iodine allergy and not considered necessary for background diabetic retinopathy; screening studies and angiography of asymptomatic contralateral eyes are not covered. Documentation of medical necessity per eye and direct physician supervision when performed by non-physician practitioners are required, and providers must notify beneficiaries in writing if services may be noncovered.

"Fluorescein angiography with interpretation is medically necessary as an adjunct to diagnosing chorioretinal vascular abnormalities, including choroidal neovascularization (CNV)."