Crystal's Coder Hub🔬 CPT 92242 — Fluorescein Angiography and Indocyanine-Green Angiography (Includes Multiframe Imaging) Performed at the Same Patient Encounter With Interpretation and Report, Unilateral or Bilateral
“Fluorescein angiography and indocyanine-green angiography (includes multiframe imaging) performed at the same patient encounter with interpretation and report, unilateral or bilateral”
Quick Reference
wRVU: 1.10 | Global Period: 000 | Assistant Payable: No | Bilateral Indicator: 2
Rule: Bilateral indicator 2 means the fee schedule rate is the same whether one or both eyes are imaged — do not append modifiers -50, -RT, or -LT. CPT 92242 is reported once per encounter. It is the exclusive code when both FA and ICG angiography are performed at the same session; billing 92235 and 92240 separately for the same encounter is considered unbundling and is never appropriate.1 CPT 92242 was introduced effective January 1, 2017, replacing the practice of separately reporting 92235 + 92240 on the same date. It received a significant payment increase effective January 1, 2025.23
📋 Clinical Description
CPT 92242 describes the performance of both fluorescein angiography (FA) and indocyanine-green angiography (ICG) at the same patient encounter — a combined dual-dye imaging session that uses two distinct contrast agents to simultaneously evaluate the retinal vasculature (FA) and the choroidal vasculature (ICG), each capturing different physiological compartments that neither dye can visualize alone.1 FA uses sodium fluorescein, a water-soluble dye that remains largely within retinal vessels due to tight retinal capillary junctions, making it ideal for imaging retinal vascular leakage, cystoid macular edema, and superficial neovascularization. ICG uses indocyanine green, a larger molecule that binds to plasma proteins and remains within the fenestrated choroidal vasculature, making it ideal for imaging choroidal neovascularization, polypoidal choroidal vasculopathy (PCV), choroidal vascular occlusions, and other deep posterior segment pathology that FA cannot adequately penetrate through the retinal pigment epithelium.2
Both dyes are administered intravenously (typically via sequential injection), and multiframe photographic imaging captures the transit of each dye through its respective vascular compartment across the arterial, arteriovenous, venous, and late phases. A single combined written interpretation and report covering both angiographic studies is required.3 The clinical value of the combined study — rather than FA alone — is greatest when a dual-compartment vascular diagnosis is suspected, such as differentiating type 1 (sub-RPE) from type 2 (sub-retinal) choroidal neovascularization, confirming PCV with ICG (which is the gold standard for PCV diagnosis), evaluating multifocal choroiditis, or characterizing central serous chorioretinopathy (CSCR) and pachychoroid spectrum disease.4
This procedure may be performed in the following clinical contexts:
- Polypoidal choroidal vasculopathy (PCV) diagnosis — ICG is the definitive imaging modality for identifying the polypoidal lesions and branching vascular networks of PCV that are invisible on FA; combined 92242 is performed when wet AMD-like presentation does not respond to anti-VEGF and PCV is suspected, guiding decisions for photodynamic therapy.2
- Exudative AMD — CNV type characterization — FA identifies leakage boundaries and CNV activity while ICG delineates the CNV morphology, extent, and feeder vessels beneath the RPE; the combined study guides anti-VEGF dosing and treatment frequency decisions.1
- Central serous chorioretinopathy (CSCR) — pachychoroid evaluation — ICG reveals the dilated outer choroidal vessels (pachyvessels), choroidal hyperpermeability, and the specific leakage points from choroidal vessels that drive the RPE detachment and neurosensory detachment seen in CSCR; FA alone cannot demonstrate these choroidal findings.3
- Multifocal choroiditis / white dot syndromes — Both retinal and choroidal inflammatory lesion activity must be characterized simultaneously; FA demonstrates retinal vascular changes and optic disc leakage while ICG demonstrates choroidal stromal involvement and lesion activity not visible on FA.4
- Retinal angiomatous proliferation (RAP lesion) — ICG identifies the intraretinal neovascular complex and retino-choroidal anastomosis that defines RAP lesions and distinguishes them from classic or occult CNV; FA alone is insufficient for RAP diagnosis and treatment planning.2
🔬 Anatomical & Procedural Considerations
| Variant | Mechanism | Key Notes |
|---|---|---|
| Sequential IV Injection FA + ICG with Digital Multiframe Camera | The patient is dilated and seated at the fundus camera. An IV line is placed in a peripheral vein (typically antecubital). Sodium fluorescein (500 mg/5 mL) is injected first; multiframe images are captured across arterial (~8–12 sec), arteriovenous, venous, and late phases (~10 min). ICG (25–50 mg) is then injected (or co-injected depending on system), and near-infrared multiframe images are captured across its transit phases, with ICG late-phase imaging extending to 30 minutes to capture choroidal details. The physician reviews all frames and authors a combined written interpretation and report. | This is the standard workflow for 92242 in a modern retinal practice equipped with a confocal scanning laser ophthalmoscope (cSLO) or a digital fundus camera with both fluorescence and near-infrared capability. Some systems allow simultaneous FA + ICG acquisition with co-injection, reducing total procedure time. Document both dye administrations, imaging phases captured, and findings for each modality separately in the interpretation and report.13 |
| Ultra-Widefield (UWF) Combined FA + ICG | Systems such as the Heidelberg Spectralis HRA with widefield module or the OPTOS UWF platform can capture up to 200° of the retina and choroid simultaneously in both FA and ICG modes. This is particularly valuable in diseases affecting the peripheral choroid (e.g., birdshot chorioretinopathy, sympathetic ophthalmia, sarcoidosis with peripheral choroidal lesions). | UWF combined angiography significantly improves detection of peripheral vascular pathology compared to 30°–55° standard fundus camera imaging. The CPT code remains 92242 regardless of the imaging platform used — the code does not distinguish between standard field and ultra-widefield acquisition. Document the imaging system used and the fields captured in the report.24 |
| OCT-Angiography as a Complement (Not a Substitute) | OCT angiography (92137) is a newer non-dye-based technique that can image retinal and choroidal vasculature using motion contrast. It complements but does not replace FA + ICG for most indications requiring dye-based leakage assessment. | OCT angiography cannot detect active vascular leakage, staining, or pooling — findings that require dye-based FA or ICG. When both OCT-A and combined FA + ICG are performed on the same day for independently documented clinical indications, both 92137 and 92242 are separately reportable (verify NCCI edits and payer-specific policies for same-day billing). |
Clinical Pearl
The single most important billing rule for CPT 92242 is that it replaces 92235 and 92240 — never report 92235 + 92240 on the same date of service when both dyes are used at the same encounter.1 Doing so is unbundling and constitutes an NCCI violation. 92242 is mutually exclusive with both 92235 and 92240 under NCCI with indicator 0 — no modifier can override this. Additionally, 92242 is mutually exclusive with 92230 (fluorescein angioscopy) and 92250 (fundus photography) on the same date — these NCCI bundles also carry indicator 0.2 Plan your claim carefully: if combined FA + ICG was performed, 92242 is your only angiography code for that date.
✅ Procedure Includes
- Intravenous sodium fluorescein injection and multiframe retinal imaging — The FA component including dye administration, all multiframe image capture across all phases, and the FA findings analysis are bundled into the single 92242 service.1
- Intravenous indocyanine-green injection and multiframe choroidal imaging — The ICG component including dye administration, all multiframe image capture across arterial, venous, and late choroidal phases, and the ICG findings analysis are similarly bundled.2
- IV access establishment — Peripheral IV placement for dye administration is integral to the procedure and not separately billable.
- Patient monitoring during dye administration — Monitoring for adverse reactions (nausea, vomiting, anaphylaxis for FA; rare but possible ICG reactions in iodine-sensitive patients) is a bundled component.3
- Combined written physician interpretation and report — A single comprehensive written report covering both the FA and ICG findings, including phase-by-phase observations, pathology characterization, and clinical conclusions, is the required documentation deliverable of 92242.4
- Image archiving and retrieval — Digital storage and retrieval of multiframe FA and ICG images is part of the imaging service and not separately billable.
❌ Excludes / Do Not Report Together
| Code | Description | Relationship |
|---|---|---|
| 92235 | Fluorescein angiography (includes multiframe imaging) with interpretation and report, unilateral or bilateral | Mutually exclusive with 92242 under NCCI (indicator 0) — when both FA and ICG are performed at the same encounter, only 92242 is reported. Reporting 92235 alongside 92242 is unbundling and constitutes an NCCI violation that no modifier can override.12 |
| 92240 | Indocyanine-green angiography (includes multiframe imaging) with interpretation and report, unilateral or bilateral | Mutually exclusive with 92242 under NCCI (indicator 0) — same rule as 92235. Never report 92240 with 92242 on the same date. 92242 is the correct and only code when both dyes are used at the same encounter.1 |
| 92230 | Fluorescein angioscopy with interpretation and report | Mutually exclusive with 92242 under NCCI (indicator 0). Angioscopy (no photography) and full multiframe angiography (with photography) are distinct service types and are not separately reportable on the same date.23 |
| 92250 | Fundus photography with interpretation and report | Mutually exclusive with 92242 under NCCI (indicator 0). Fundus photography is not separately reportable on the same day as 92242. If fundus photographs were obtained as part of the angiography setup or baseline imaging, they are bundled into the angiography service.2 |
Bundling Alert
CPT 92242 has four mutually exclusive NCCI bundles (with 92235, 92240, [[92230]], and 92250) — all with indicator 0, meaning no modifier can override any of them.2 These four codes are never reportable alongside 92242 on the same date, under any clinical circumstance, for any payer following NCCI edits. In addition, certain injection and IV access CPT codes (e.g., 36000, 96360, 96365, 96374) are bundled with 92242 with indicator 1 (modifier-bypassable) — meaning in unusual circumstances where separately documented IV services are performed, modifier -59 may allow separate billing, but this should be exceedingly rare in routine angiography practice.1 Verify with your payer’s specific NCCI edit table before attempting to unbundle any of the indicator 1 pairs.
🌳 Code Tree — Medicine: Ophthalmology — Posterior Segment Angiography
CPT 92002–92499 Medicine: Ophthalmology
│
├── 92201–92202 Ophthalmoscopy Procedures
│ ├── 92201 Ophthalmoscopy, extended; peripheral retinal, scleral depression (Global: 000)
│ └── 92202 Ophthalmoscopy, extended; optic nerve or macula (Global: 000)
│
├── 92230–92260 Posterior Segment Ophthalmic Procedures
│ ├── 92230 Fluorescein angioscopy with interpretation and report (Global: 000)
│ ├── 92235 Fluorescein angiography (includes multiframe imaging) with interpretation and report, unilateral or bilateral (Global: 000)
│ ├── 92240 Indocyanine-green angiography (includes multiframe imaging) with interpretation and report, unilateral or bilateral (Global: 000)
│ ├── ▶▶ 92242 ◀◀ Fluorescein angiography and ICG angiography (includes multiframe imaging) performed at same encounter with interpretation and report, unilateral or bilateral ← YOU ARE HERE (Global: 000)
│ └── 92250 Fundus photography with interpretation and report (Global: 000)
│
├── 92133–92134 Scanning Computerized Ophthalmic Diagnostic Imaging (OCT)
│ ├── 92133 OCT, anterior segment with interpretation and report (Global: 000)
│ └── 92134 OCT, posterior segment with interpretation and report (Global: 000)
│
└── 92227–92229 Remote Retinal Imaging
├── 92227 Remote imaging for detection of retinal disease (Global: 000)
└── 92228 Remote imaging for monitoring of active retinal disease (Global: 000)
💰 RVU & Reimbursement Profile
| Component | Value |
|---|---|
| Work RVU | 1.10 |
| Global Period | 000 |
| Bilateral Indicator | 2 — Priced as unilateral or bilateral; do not append -50, -RT, or -LT |
| Assistant Surgeon | Not applicable |
| Co‑Surgeon | Not applicable |
| Team Surgery | Not applicable |
| PC/TC Split | 0 — No professional/technical component split; reported as a unified service |
| Modifier -51 Exempt | No |
| Anesthesia | Not applicable |
Bilateral Billing Rules
CPT 92242 carries bilateral indicator 2 — the fee schedule rate is identical whether one or both eyes are imaged with both dyes. Never append -50, -RT, or -LT to 92242. Report only one unit per encounter regardless of laterality. Note that the CMS 2025 Medicare Physician Fee Schedule included a significant payment increase for 92242 (and 92240), reflecting updated RVU valuations. Always verify current year fee schedule amounts with your MAC or CMS MPFS Lookup Tool for exact 2026 payment rates in your locality.23
🏷️ Modifier Reference
| Modifier | Name | When to Apply |
|---|---|---|
| -25 | Significant, Separately Identifiable E/M Service | Append -25 to the eye exam or E/M code (not to 92242) on the same day when a comprehensive or intermediate eye exam is also billed. The exam must represent a significant, separately identifiable service with its own documentation independent of the angiography decision.1 |
| -59 | Distinct Procedural Service | Apply to 92242 when a payer-specific bundling edit (indicator 1 only) would otherwise package it with another same-day service that is genuinely distinct. Never use -59 to override the indicator 0 mutual exclusion bundles with 92235, 92240, 92230, or 92250.2 |
| -52 | Reduced Services | Use if only a partial FA + ICG study was completed due to adverse dye reaction, patient non-cooperation, or technical failure, with documentation explaining the incomplete study. Expect reduced reimbursement. |
| -53 | Discontinued Procedure | Apply if dye administration was prepared but the procedure was discontinued before any meaningful images were captured due to a patient adverse event or clinical emergency. |
| -GQ | Via Asynchronous Telecommunications | Applicable when the combined FA + ICG interpretation and report is provided via store-and-forward telehealth; verify eligibility under current CMS and MAC telehealth policy. |
| -GT | Via Interactive Audio and Video | Applied when telehealth delivery modality applies; confirm 92242 remains on the applicable telehealth-eligible procedure list. |
Modifiers NOT applicable to 92242
🩺 Common ICD‑10‑CM Pairings
Primary Diagnosis Group
| ICD‑10 | Description | HCC? | Notes |
|---|---|---|---|
| H35.3211 | Exudative age-related macular degeneration, right eye, with active choroidal neovascularization | No | The highest-yield primary pairing for 92242; combined FA + ICG is the standard of care for characterizing CNV type, extent, and activity in wet AMD, particularly when differentiating type 1 from type 2 CNV and when PCV is suspected. Left eye is H35.3221.1 |
| H31.001 | Choroidal neovascularization, unspecified, right eye | No | Use when the etiology of CNV is not AMD — such as pathologic myopia, POHS, or idiopathic CNV. Code the underlying etiology when known rather than defaulting to H31.001.3 |
| H35.173 | Retinal telangiectasis, bilateral | No | Macular telangiectasia type 2 (MacTel) has characteristic findings on both FA (perifoveal leakage) and ICG (choroidal attenuation) that together define the disease stage and guide treatment.4 |
| H30.001 | Unspecified focal chorioretinal inflammation, right eye | No | Combined FA + ICG characterizes both the retinal and choroidal inflammatory components in focal chorioretinitis, distinguishing active from atrophic lesions and identifying associated choroidal neovascularization.2 |
| H34.8110 | Central retinal vein occlusion, right eye, with macular edema | No | When ICG is added to FA in CRVO evaluation, it provides additional information about choroidal ischemia and choroidal vascular contributions to macular edema beyond what FA alone shows. |
Secondary Group
| ICD‑10 | Description | HCC? | Notes |
|---|---|---|---|
| H35.721 | Vitelliform macular dystrophy, right eye (Best disease) | No | Combined FA + ICG characterizes the stage of Best disease and identifies any associated CNV; ICG is particularly valuable for evaluating the RPE and choroidal components of vitelliform lesions.3 |
| H31.101 | Choroidal degeneration, unspecified, right eye | No | Age-related choroidal atrophy and geographic atrophy-associated choroidal changes are better characterized with ICG; use when FA alone is insufficient for clinical characterization.4 |
Etiology / Complication
| ICD‑10 | Description | HCC? | Notes |
|---|---|---|---|
| H35.3510 | Pigment epithelial detachment, right eye, unspecified | No | PED morphology (drusenoid vs. serous vs. fibrovascular) is best differentiated by combined FA + ICG; FA shows the leakage pattern while ICG confirms the nature of the subRPE material.2 |
| H30.211 | Posterior cyclitis, right eye | No | In panuveitis with posterior involvement, combined angiography characterizes both the retinal vasculitis (FA) and choroidal involvement (ICG), supporting diagnosis and treatment intensity decisions.1 |
Coding Specificity Reminder
Exudative AMD codes (H35.32xx) require laterality and the specific neovascular membrane activity status — use H35.3211 for right eye with active CNV, H35.3213 for right eye with regressed CNV, etc. For PCV, there is currently no specific ICD-10-CM code — use H35.3211 (wet AMD with active CNV) or H31.001 (CNV, unspecified) based on clinical documentation, as PCV is classified under the AMD or CNV umbrella in ICD-10-CM. Choroidal neovascularization codes (H31.00x) require laterality. Never leave laterality unspecified if the physician’s documentation identifies the affected eye(s).34
🏥 MS‑DRG Considerations
CPT 92242 is a diagnostic Medicine/ophthalmology imaging service that does not independently drive MS-DRG assignment. It is almost exclusively performed in the outpatient/office setting, making inpatient billing of 92242 rare. In the uncommon event that combined FA + ICG is performed on a hospitalized patient (e.g., a patient admitted for acute vision loss with suspected neovascular AMD or uveitis requiring combined angiographic characterization), the service appears on the physician’s professional claim and does not affect the facility’s DRG. The principal diagnosis and any therapeutic ICD-10-PCS procedures determine DRG assignment under MDC 02. DRGs 124–126 (Other Disorders of the Eye with and without CC/MCC) are the most applicable inpatient DRGs. The underlying retinal or choroidal diagnosis ICD-10-CM codes (not the imaging procedure CPT code) drive any CC/MCC complexity capture on the facility claim.14
🔧 ICD‑10‑PCS Equivalents
Note
CPT 92242 involves IV dual-dye administration and multiframe photographic imaging of the retinal and choroidal vasculature. ICD-10-PCS captures retinal and choroidal imaging under Section B (Imaging), Body System 8 (Eye), Root Type 3 (Fluoroscopy) or 4 (Ultrasonography). There is no specific PCS code for combined FA + ICG; the imaging section captures each dye type under its respective PCS imaging modality.
| PCS Code | Full Description | Modality |
|---|---|---|
| B80YZZZ | Fluoroscopy of Other Eye | FA component — fluorescein is a contrast agent visualized under fluorescent illumination; PCS categorizes this under fluoroscopy for the eye |
| B80YZZZ | (Same code — PCS does not have a separate ICG-specific eye imaging code) | ICG component — no distinct PCS code exists for ICG choroidal angiography separate from FA |
| 08J0XZZ | Inspection of Right Eye, External Approach | Physician real-time observation component of the angiographic examination |
| 4A07XVZ | Measurement of Eye, Ophthalmologic, External Approach | Physiological ophthalmic assessment — applicable when vascular dynamics are the measured parameter |
PCS Character Analysis (using B80YZZZ as primary example for FA imaging component)
| Position | Character | Value | Definition |
|---|---|---|---|
| 1 | Section | B | Imaging — the PCS section dedicated to diagnostic imaging procedures that produce visual representations of anatomical structures. |
| 2 | Body System | 8 | Eye — encompasses all ocular structures including the retina, choroid, and retinal/choroidal vasculature. |
| 3 | Root Type | 0 | Plain Radiography — note: PCS does not have a perfect match for fundus fluorescein angiography; B800 (Plain Radiography of Eye) is the closest structural fit, though the modality differs. Fluoroscopy (B801) may be argued as more appropriate for the dynamic phase-based imaging. |
| 4 | Body Part | Y | Other Eye — used when the specific laterality or structure is not captured by a more defined body part value. |
| 5 | Contrast | Z | None — PCS contrast values (High Osmolar, Low Osmolar) do not directly map to IV fluorescein or ICG; Z (None) is used as the closest available value. |
| 6 | Qualifier | Z | No Qualifier |
| 7 | Qualifier | Z | No Qualifier |
Root Operation Comparison
- Section B (Imaging) vs. Section 0 (Inspection): Section B is more appropriate than Section 0 for the multiframe photographic component of 92242 because the dominant service is image acquisition and diagnostic documentation — not purely physician visual inspection. However, PCS does not have granular codes distinguishing FA from ICG from OCT in the eye imaging context, making precise PCS mapping imperfect.
- Practical note for inpatient coding: Combined FA + ICG angiography is almost never performed in the inpatient setting, and ICD-10-PCS codes for this service would rarely appear on a UB-04 facility claim. The ophthalmologist’s professional services are captured on the CMS-1500 using CPT 92242.
- ICD-10-PCS Administration codes: The IV fluorescein and ICG injections could technically be coded under Section 3 (Administration) — Introduction of a substance into the peripheral vein — but in practice, the injection is integral to the imaging service and is not separately coded in PCS for this diagnostic procedure.1
📝 Coding Examples
Example 1 — Wet AMD With Suspected PCV, ICG-Confirmed Polyps
Clinical Scenario:
A 74-year-old established patient with known exudative AMD in the right eye has had a suboptimal response to six monthly anti-VEGF injections. The retinal specialist suspects polypoidal choroidal vasculopathy (PCV) based on the “thumb-print” pigment epithelial detachment pattern on OCT. To confirm PCV and guide potential PDT treatment, combined FA + ICG angiography is performed. FA demonstrates late leakage and a well-defined hyperfluorescent lesion with surrounding hypofluorescence; ICG demonstrates the classic early hyperfluorescent polypoidal structures and branching vascular network at the posterior pole, confirming the PCV diagnosis. An intermediate examination is also performed. The physician authors a comprehensive interpretation and report covering both angiographic studies.
| Field | Code | Rationale |
|---|---|---|
| CPT 1 | 92012-25 | Intermediate established patient eye exam; modifier -25 on the exam code for a significant, separately identifiable service beyond the decision to perform angiography. |
| CPT 2 | 92242 | Combined FA + ICG angiography, same encounter, multiframe imaging, interpretation and report. Single unit; bilateral indicator 2 — no laterality modifier.1 |
| PDx | H35.3211 | Exudative AMD, right eye, with active choroidal neovascularization — PCV is classified under the wet AMD/CNV codes in ICD-10-CM; code to the highest specificity documented.3 |
Note
Do NOT also report 92235 or 92240 — they are mutually exclusive with 92242 (NCCI indicator 0). The combined code 92242 is the correct and only angiography code when both dyes are used at the same encounter. The OCT (92134) performed at this visit is separately reportable with its own documented medical necessity.2
Example 2 — Central Serous Chorioretinopathy With Pachychoroid Evaluation
Clinical Scenario:
A 47-year-old established patient with recurrent central serous chorioretinopathy (CSCR) in the left eye presents for evaluation after a recurrence of blurred vision and metamorphopsia. The retinal specialist performs combined FA + ICG angiography to characterize the leakage points driving the neurosensory retinal detachment (FA) and evaluate the pachychoroid features including dilated outer choroidal vessels and focal choroidal hyperpermeability (ICG). FA demonstrates a smokestack pattern of fluorescein leakage at the superior macula; ICG demonstrates focal choroidal hyperpermeability at the leakage point with pachyvessels underlying the fovea. The physician writes a combined interpretation and report supporting chronic CSCR with pachychoroid features and recommends low-fluence PDT.
| Field | Code | Rationale |
|---|---|---|
| CPT 1 | 92012-25 | Intermediate established patient eye exam; -25 on exam code. |
| CPT 2 | 92242 | Combined FA + ICG, same encounter, left eye primary focus; bilateral indicator 2 — no -LT modifier appended. Single unit.12 |
| PDx | H35.711 | Central serous chorioretinopathy, right eye — use left eye equivalent H35.712; bilateral H35.713 if bilateral involvement documented. |
Warning
Do NOT report 92134 (OCT) AND 92242 without verifying payer-specific NCCI edits for same-day billing of these two codes. Most payers allow both when independently documented, but some have payer-specific bundling policies. Append modifier -59 to 92134 if needed with appropriate documentation of independent medical necessity for each imaging modality.24
Example 3 — Multifocal Choroiditis With Active Lesions, No Concurrent Exam
Clinical Scenario:
A 33-year-old established patient with known multifocal choroiditis (MFC) and panuveitis returns specifically for surveillance combined angiography as planned at the prior visit. No comprehensive examination is performed today — only the angiographic evaluation. Combined FA + ICG is performed bilaterally. FA demonstrates active hyperfluorescent inflammatory lesions at the nasal periphery of the right eye and peripapillary area of the left eye; ICG demonstrates additional choroidal lesion activity not visible on FA in both eyes, with no CNV identified. The physician writes a bilateral combined interpretation and report noting active choroidal inflammatory disease in both eyes and increasing the oral steroid dose.
| Field | Code | Rationale |
|---|---|---|
| CPT | 92242 | Combined FA + ICG, bilateral; bilateral indicator 2 — single unit, no -50 modifier. No concurrent exam billed today. Combined interpretation and report covers both eyes and both dye studies.13 |
| PDx | H30.123 | Diffuse posterior cyclitis, bilateral — use the most specific chorioretinitis code supported by documentation; bilateral code preferred when both eyes are affected. |
Global period reminder
CPT 92242 carries a global period of 000 — there is no post-procedure period. If the patient receives a sub-Tenon’s steroid injection (67515) at the same visit or a subsequent visit this week, verify NCCI bundling between 92242 and the injection code for same-day claims. The angiographic findings driving the treatment decision support medical necessity for both services when performed on the same date with documented separate clinical rationale.4
⚠️ Common Coding Pitfalls
- Pitfall 1 — Reporting 92235 + 92240 instead of 92242: The most common billing error for this service — submitting two separate angiography codes when both FA and ICG are performed at the same encounter. This is unbundling under NCCI. CPT 92242 is the only correct code when both dyes are used at the same session, regardless of whether one or both eyes are imaged.12
- Pitfall 2 — Appending -RT, -LT, or -50: Bilateral indicator 2 means laterality and bilateral modifiers are never appropriate for 92242. A common error in offices that apply these modifiers to all angiography codes — 92242 should be submitted as a single unit with no laterality modifier regardless of whether one or both eyes were imaged.1
- Pitfall 3 — Reporting 92242 and 92250 on the same date: The NCCI bundle between 92242 and 92250 carries indicator 0 — it cannot be overridden by any modifier. Fundus photography is not separately reportable alongside 92242. Images captured as part of the angiographic session setup are considered bundled.23
- Pitfall 4 — Reporting 92242 and 92230 on the same date: Similarly, the NCCI bundle between 92242 and 92230 carries indicator 0. Fluorescein angioscopy and combined FA + ICG angiography cannot be billed together under any circumstance.2
- Pitfall 5 — Billing 92242 when only one dye was used: If only fluorescein was administered and imaged (no ICG performed), the correct code is 92235, not 92242. If only ICG was administered and imaged, the correct code is 92240. CPT 92242 requires that both FA and ICG be performed at the same encounter — billing 92242 for a single-dye session is upcoding.13
- Pitfall 6 — Inadequate combined interpretation and report: The written interpretation must address findings from both the FA and ICG components — a report that describes only fluorescein findings without documenting ICG phase observations does not fully support the 92242 service, as the entire clinical value of the combined study is the dual-compartment assessment. Each modality’s key phases, findings, and clinical implications must be documented.4