Clinical Scorecard: Coding: Reimbursement for OCT Angiography

At a Glance

Key Highlights

• New CPT code 92137 introduced for OCT angiography including interpretation and report.
• OCTA provides high-resolution, dye-free imaging of retinal and choroidal vasculature using movement of red blood cells.
• Medicare payment for CPT 92137 is $57 nationally, with technical and professional components, subject to MPPR.

Guideline-Based Recommendations

Diagnosis

• Use OCTA to diagnose retinal vascular diseases such as diabetic retinopathy, AMD, vascular occlusions, and macular telangiectasia.
• Apply OCTA for optic nerve conditions including glaucoma vascular factors, AION, and optic neuritis.
• Employ OCTA in uveitis for inflammatory vasculitis, birdshot chorioretinopathy, and cystoid macular edema.
• Consider OCTA in neurology for Alzheimer's disease and other dementias.

Management

• Document detailed findings beyond 'abnormal' to support medical necessity.
• Do not report CPT 92137 on the same date as codes 92133 or 92134.
• Obtain appropriate patient financial responsibility forms (ABN, NEHB) when coverage is uncertain.

Monitoring & Follow-up

• Monitor payor policies and Local Coverage Articles for updates on coverage and reimbursement.
• Track claims processing and payment rates to ensure correct reimbursement.
• Educate staff on new code usage and documentation requirements.

Risks

• Potential patient financial liability if payors deny coverage due to newness of code.
• Risk of improper coding if CPT 92137 is billed with conflicting codes on the same day.
• Possible delays or denials in reimbursement due to limited payor guidance.

Patient & Prescribing Data

Patients undergoing retinal, optic nerve, uveitis, or neurological vascular evaluation

OCTA is a safer, faster alternative to dye-based angiography with fewer adverse reactions and provides detailed vascular imaging to guide diagnosis and monitoring.

Clinical Best Practices

• Ensure thorough documentation of OCTA findings with precise descriptions and image storage locations.
• Inform patients about potential noncoverage and obtain appropriate financial responsibility notices prior to testing.
• Separate billing of CPT 92137 from other OCT codes on the same day to comply with CPT guidelines.
• Stay updated on Medicare and commercial payer policies regarding OCTA coverage and reimbursement.
• Educate clinical and billing staff on the new CPT code and related documentation and billing requirements.

References

• Koustenis A Jr et al. Optical coherence tomography angiography overview
• Leitgeb RA. En face optical coherence tomography technology review
• Le PH, Kaur K, Patel BC. Optical Coherence Tomography Angiography - StatPearls
• AAO EyeWiki. Optical coherence tomography angiography
• Rifai OM et al. OCTA in Alzheimer’s disease systematic review
• First Coast Solutions Medicare Administrative Contractor
• Novitas Solutions Medicare Administrative Contractor
• 2025 CPT Professional Edition