Coding: Reimbursement for OCT Angiography

Clinical Report: Reimbursement and Coding for OCT Angiography in 2025

Overview

The 2025 CPT Handbook introduces a new procedure code 92137 for OCT angiography (OCTA), enabling standardized reporting and reimbursement. OCTA offers a non-invasive, dye-free imaging technique for retinal and optic nerve vascular assessment, with a Medicare allowable fee of $57 for bilateral testing.

Background

Optical coherence tomography angiography (OCTA) is an advanced imaging modality that provides high-resolution, non-invasive visualization of retinal and choroidal vasculature without the need for dye injection. It improves upon traditional OCT by offering en face transversal imaging, aiding diagnosis and monitoring of various retinal, optic nerve, uveitis, and neurological conditions. The new CPT code 92137 facilitates billing for OCTA, but payor coverage and documentation requirements remain evolving. Clinicians must understand coding nuances and patient financial responsibilities due to limited payer policies.

Data Highlights

Parameter	Value
CPT Code	92137
Procedure Description	Computerized ophthalmic diagnostic imaging, retina including OCT angiography
Medicare National Allowable Fee (2025)	$57 (unadjusted)
Technical Component	$23
Professional Component	$34
Payment Basis	Bilateral (one or both eyes)
Medicare MPPR	Applies to technical component when multiple tests performed same day

Key Findings

CPT code 92137 is newly introduced for OCT angiography, covering unilateral or bilateral retinal imaging with interpretation and report.
OCTA provides non-invasive, dye-free imaging of retinal and choroidal vessels using motion contrast from red blood cells, reducing risk and procedure time.
Clinical indications include diabetic retinopathy, AMD, vascular occlusions, glaucoma-related optic nerve changes, uveitis, and neurological diseases such as Alzheimer’s.
Medicare’s 2025 allowable fee is $57 total, split between technical ($23) and professional ($34) components, with payment considered bilateral.
Documentation must be thorough, detailing findings and image storage location; vague notes like “abnormal” are insufficient.
Payor coverage is currently limited and variable; patient financial responsibility may be necessary with appropriate notices such as ABN or NEHB.

Clinical Implications

Clinicians should familiarize themselves with CPT 92137 coding guidelines and ensure comprehensive documentation to support claims. Due to limited payer policies, it is essential to inform patients about potential out-of-pocket costs and obtain necessary advance beneficiary notices. Monitoring claim processing and reimbursement patterns will help optimize practice workflows and financial planning.

Conclusion

The introduction of CPT code 92137 for OCT angiography marks an important step in standardizing reimbursement for this advanced imaging modality. Careful attention to coding, documentation, and patient communication will facilitate appropriate utilization and coverage.

PentaVision

Ophthalmic Professional