Crystal's MCW Coder Hub⚕️CPT Code 92240 - Indocyanine-Green Angiography
Full Description: Indocyanine-green angiography (includes multiframe imaging) with interpretation and report, unilateral or bilateral. (Descriptor revised 1/1/2017)
🔬 Procedure Overview
Indocyanine-green (ICG) angiography is a diagnostic ophthalmic imaging procedure in which indocyanine green dye — a fluorescent dye that absorbs near-infrared light (peak absorption ~805 nm, peak emission ~835 nm) — is injected intravenously. A fundus camera or scanning laser ophthalmoscope equipped with infrared filters then captures multiframe sequential images of the retinal and choroidal vasculature as the dye circulates through the posterior segment of the eye.
ICG dye binds strongly to plasma proteins (~98%), which limits its leakage through the fenestrated choriocapillaris. This property makes ICG angiography uniquely superior to fluorescein angiography (FA) for visualizing deep choroidal circulation, structures beneath the retinal pigment epithelium (RPE), and pathology obscured by hemorrhage, lipid, or turbid subretinal fluid. The imaging captures three phases:
| Phase | Timeframe | What is Visualized |
|---|---|---|
| Early (Arterial) | 0-30 seconds | Choroidal arteries, choriocapillaris filling |
| Mid (Venous) | 1-5 minutes | Choroidal veins, early leakage patterns |
| Late | 15-30 minutes | Residual staining, hot spots, plaques |
The interpreting physician reviews all frames and generates a formal written interpretation and report, which must be documented in the medical record.
📋 Code Details
| Field | Detail |
|---|---|
| CPT Code | 92240 |
| Full Descriptor | Indocyanine-green angiography (includes multiframe imaging) with interpretation and report, unilateral or bilateral |
| Category | Medicine - Ophthalmology |
| Subcategory | Ophthalmoscopy Procedures |
| Global Period | XXX (not a surgical procedure; global concept does not apply) |
| wRVU (2025-2026) | ~1.36 (received a reimbursement increase in 2025) |
| Medicare Reimbursement (National Avg) | ~175 (non-facility); varies by locality and year |
| Place of Service | Office (11), Outpatient Hospital (22), Independent Clinic (49), FQHC (50), RHC (72) |
| ASC Payable | No (not on ASC payable list for global; physician-only or TC may apply) |
| Assistant Surgeon Payable | ❌ No |
| Bilateral | ✅ Yes - procedure is unilateral OR bilateral; no modifier needed for bilateral; billed once regardless |
| Technical Component (TC) Billable | ✅ Yes - modifier TC |
| Professional Component Billable | ✅ Yes - modifier [ cms] |
Caution
⚠️ Note on 2025 RVU Update: CPT 92240 received a significant positive reimbursement update effective January 1, 2025 under the Medicare Physician Fee Schedule (MPFS), making it one of the select ophthalmic diagnostic codes to see a generous raise that year. The 2026 MPFS applies a standard 2.5% wRVU decrease to most codes, so verify current locality-specific rates via the CMS Physician Fee Schedule lookup tool.
✅ What Is Included (Bundled Into 92240)
The following services are all-inclusive within 92240 and cannot be billed separately:
- Indocyanine-green dye (the cost of the ICG dye itself is bundled)
- Intravenous line setup and insertion
- Dye injection
- Camera setup and calibration
- All imaging frames (multiframe imaging is explicitly included in descriptor)
- Physician supervision during imaging
- Interpretation of results
- Written report/documentation
📌 Do NOT separately bill for the dye, the IV insertion, or the image acquisition when 92240 is reported — these are considered integral components of the procedure.
🚫 Excludes / Cannot Bill Together
| Code | Description | Reason |
|---|---|---|
| 92235 | Fluorescein angiography (FA) | If FA and ICG are both performed at the same encounter, do NOT bill 92235 + 92240 — use 92242 instead |
| 92230 | Fluorescein angioscopy | Typically not reported on the same day as ICG |
| Dye/supply codes separately | ICG dye supply | Cost is bundled; not separately billable |
⚠️ Critical Bundling Rule: If both FA (92235) and ICG angiography (92240) are performed at the same patient encounter, you must report 92242 (Fluorescein angiography and indocyanine-green angiography [includes multiframe imaging] performed at the same patient encounter with interpretation and report, unilateral or bilateral) — NOT 92235 and 92240 together.
🧩 Code Tree / Related Codes
Special Ophthalmological Services and Procedures - Ophthalmoscopy (CPT 92201-92260) │ ├── 92201 - Ophthalmoscopy, extended; with retinal drawing and scleral depression, initial ├── 92202 - Ophthalmoscopy, extended; with retinal drawing and scleral depression, subsequent ├── 92225 - Ophthalmoscopy, extended; with retinal drawing, initial ├── 92226 - Ophthalmoscopy, extended; with retinal drawing, subsequent ├── 92227 - Imaging of retina for detection or monitoring, unilateral or bilateral (remote) ├── 92228 - Imaging of retina, remote physician interpretation, low complexity ├── 92229 - Imaging of retina, point-of-care autonomous analysis ├── 92230 - Fluorescein angioscopy with interpretation and report ├── 92235 - Fluorescein angiography (FA) with interpretation and report ├── 92240 - Indocyanine-green (ICG) angiography with interpretation and report ← YOU ARE HERE ├── 92242 - FA + ICG angiography performed at same encounter ├── 92250 - Fundus photography with interpretation and report └── 92260 - Ophthalmodynamometry │ └── Related Functional/Vascular Codes ├── 92100 - Serial tonometry (IOP; distinct from ODM) ├── 93880 - Carotid duplex scan, bilateral (often ordered alongside ODM for carotid evaluation) └── 0198T - Measurement of ocular blood flow by repetitive IOP sampling (investigational)
🏷️ Applicable Modifiers
| Modifier | Name | When to Use with 92240 |
|---|---|---|
| -26 | Professional Component | Bill when physician interprets results only; facility/tech owns equipment |
| -TC | Technical Component | Bill when facility performs imaging only; physician bills -26 separately |
| -RT | Right Side | Indicate right eye only (when unilateral) |
| -LT | Left Side | Indicate left eye only (when unilateral) |
| -50 | Bilateral | ⚠️ Generally NOT needed — descriptor already states “unilateral or bilateral”; bill once. Verify payer policy |
| -59 | Distinct Procedural Service | Use if ICG is clearly distinct from another separately reportable service on the same date |
| -76 | Repeat Procedure - Same Physician | If the same physician repeats ICG on the same day |
| -77 | Repeat Procedure - Different Physician | If a different physician repeats ICG on the same day |
| -GY | Item/Service Statutorily Excluded | Non-covered service; use to indicate intentional non-coverage |
| -GA | Waiver of Liability on File | Use when an ABN is on file for potential Medicare non-coverage |
💡 Modifier [ cms] vs. -TC Split Billing: When the ophthalmologist uses a hospital-owned imaging system, the facility bills -TC and the physician bills [ cms]. In private practice (physician-owned equipment), the global service is billed without a modifier.
🩺 ICD-10-CM Codes That Support Medical Necessity
The following ICD-10-CM codes are commonly linked to 92240 per CMS LCD coverage criteria for ophthalmic angiography. HCC (Hierarchical Condition Category) mapping is noted where applicable — important for risk adjustment and value-based care tracking.
Age-Related Macular Degeneration (AMD)
| ICD-10 Code | Description | HCC |
|---|---|---|
| H35.31- | Nonexudative (dry) AMD, right eye | — |
| H35.32- | Nonexudative (dry) AMD, left eye | — |
| H35.33- | Nonexudative (dry) AMD, bilateral | — |
| H35.311- | Dry AMD, right eye, early | — |
| H35.321- | Dry AMD, left eye, early | — |
| H35.341 | Wet AMD (exudative), right eye, with active choroidal neovascularization | ✅ HCC 122 |
| H35.342 | Wet AMD (exudative), left eye, with active choroidal neovascularization | ✅ HCC 122 |
| H35.343 | Wet AMD (exudative), bilateral, with active choroidal neovascularization | ✅ HCC 122 |
Choroidal Neovascularization (CNV)
| ICD-10 Code | Description | HCC |
|---|---|---|
| H35.051 | Retinal neovascularization, unspecified, right eye | — |
| H35.052 | Retinal neovascularization, unspecified, left eye | — |
| H35.053 | Retinal neovascularization, unspecified, bilateral | — |
Diabetic Retinopathy (Select Examples)
| ICD-10 Code | Description | HCC |
|---|---|---|
| E11.3411 | Type 2 DM with severe NPDR with macular edema, right eye | ✅ HCC 18 |
| E11.3412 | Type 2 DM with severe NPDR with macular edema, left eye | ✅ HCC 18 |
| E11.3511 | Type 2 DM with proliferative DR with macular edema, right eye | ✅ HCC 18 |
| E11.3512 | Type 2 DM with proliferative DR with macular edema, left eye | ✅ HCC 18 |
| E10.3511 | Type 1 DM with proliferative DR with macular edema, right eye | ✅ HCC 18 |
| E10.3512 | Type 1 DM with proliferative DR with macular edema, left eye | ✅ HCC 18 |
📌 HCC Note: Diabetic retinopathy with complication codes (under E10.-/E11.-) map to HCC 18 (Diabetes with Ophthalmologic Manifestations) in the CMS-HCC model, which carries a risk adjustment factor. Always code the underlying DM with the retinal complication as a combination code — do not code them separately.
Retinal Vascular Occlusion
| ICD-10 Code | Description | HCC |
|---|---|---|
| H34.10 | Central retinal artery occlusion, unspecified eye | — |
| H34.11 | Central retinal artery occlusion, right eye | — |
| H34.12 | Central retinal artery occlusion, left eye | — |
| H34.8110 | Central retinal vein occlusion, right eye, with macular edema | — |
| H34.8120 | Central retinal vein occlusion, left eye, with macular edema | — |
Choroidal / Retinal Tumors
| ICD-10 Code | Description | HCC |
|---|---|---|
| C69.31 | Malignant neoplasm of right choroid | ✅ HCC 12 |
| C69.32 | Malignant neoplasm of left choroid | ✅ HCC 12 |
| D31.21 | Benign neoplasm of right retina | — |
| D18.09 | Hemangioma of other sites (inc. choroidal hemangioma) | — |
Other Covered Indications
| ICD-10 Code | Description | HCC |
|---|---|---|
| H30.001 | Unspecified focal chorioretinal inflammation, right eye | — |
| H30.002 | Unspecified focal chorioretinal inflammation, left eye | — |
| H30.101 | Unspecified disseminated chorioretinal inflammation, right eye | — |
| H31.001 | Choroidal neovascularization, unspecified, right eye | — |
| H31.002 | Choroidal neovascularization, unspecified, left eye | — |
| H31.003 | Choroidal neovascularization, unspecified, bilateral | — |
| H35.711 | Central serous chorioretinopathy, right eye | — |
| H35.712 | Central serous chorioretinopathy, left eye | — |
| H35.713 | Central serous chorioretinopathy, bilateral | — |
🏥 MS-DRG Applicability
MS-DRG: ❌ Not directly applicable.
CPT 92240 is a diagnostic outpatient procedure billed under the physician fee schedule (Part B) or HOPD/ASC fee schedules. It is not a procedure that drives inpatient MS-DRG assignment on its own. However, if a patient is admitted inpatient and the underlying diagnosis (e.g., wet AMD, diabetic retinopathy with vision loss) contributes to the principal/secondary diagnosis, those ICD-10-CM diagnoses (such as H35.341 or E11.3511) would factor into MS-DRG grouping for the inpatient stay.
💡 Coding Examples
Example 1 - Global Billing in Private Practice (Wet AMD, Bilateral)
A retina specialist in a private practice setting performs bilateral ICG angiography on a 74-year-old Medicare patient with known wet AMD in both eyes. The physician uses the practice-owned fundus camera, performs the IV injection and imaging personally, and dictates a formal interpretation and report.
Bill:
- 92240 (global, no modifier — unilateral or bilateral, billed once)
- H35.343 (Wet AMD, bilateral, with active choroidal neovascularization)
Example 2 - Split Professional/Technical Component (HOPD Setting)
Same procedure, but performed at a hospital outpatient retina clinic where the hospital owns the equipment.
Physician Bills:
Facility Bills:
Example 3 - ICG + FA Performed at Same Encounter (Do NOT Double-Bill)
During the same visit, the retina specialist performs both fluorescein angiography AND ICG angiography on a patient with central serous chorioretinopathy.
❌ INCORRECT:
✅ CORRECT:
Example 4 - Repeat ICG by Same Physician (Monitoring Treatment Response)
A patient with wet AMD returns 6 weeks post anti-VEGF injection. The same retina specialist performs ICG angiography to assess treatment response on the right eye only.
Bill:
📝 Document clearly in the chart the medical necessity for the repeat study, including the clinical question being answered (e.g., persistent CNV activity, response to anti-VEGF, new lesion evaluation).
Example 5 - Non-Covered Service / ABN Required
An 80-year-old Medicare patient requests ICG angiography for dry AMD at an early stage without documented CNV or other covered indication under the applicable LCD.
Action: Obtain a signed ABN (Advance Beneficiary Notice) Bill:
📎 Documentation Requirements
For 92240 to be correctly reported and defensible on audit, the medical record must include:
- Clinical indication / diagnosis - clearly documented reason for ICG angiography (e.g., “evaluate extent of CNV in wet AMD”)
- Informed consent - documented for IV dye injection (allergic risk, including iodine sensitivity)
- Physician supervision - must be directly supervised or personally performed
- Multiframe images - image files stored in the patient’s record
- Written interpretation and report - dated, signed, addressing findings in all captured phases (early, mid, late)
- Plan of action - how findings affect management (e.g., “ICG confirms type 1 CNV; proceed with intravitreal anti-VEGF”)
⚠️ A “normal” interpretation still requires documentation. Simply notating “ICG performed” without a written report is insufficient for code support.
🔁 Payer Considerations
- Medicare: Covered under LCD L34426 (Ophthalmic Angiography - Fluorescein and Indocyanine Green); requires a covered ICD-10 diagnosis
- Medicaid: Coverage varies by state; verify with your state MAC
- Private Payers: Most major commercial payers (Aetna, BCBS, UHC, Cigna) cover ICG angiography for medically indicated retinal/choroidal disease; some require prior authorization
- CMS LCD Group: Group 3 ICD-10 codes specifically support 92240 (distinct from Group 1/2 which apply to fluorescein)
- Technical Component in FQHC/RHC: The TC is payable in FQHC (50) and RHC (72) settings per CMS guidance
Sources: CMS LCD L34426 · CMS Article A57069 · AAPC Codify 92240 · AMA CPT 2025 · AOA Coding Bulletin Jan 2017 · Ophthalmic Professional 2025 Update · StatPearls ICG Angiography · PayerPrice 92240 Fee Schedule · FindACode 92240 · AMA RUC Sept 2023 Meeting Minutes