OCTA Documentation, Frequency, and NCCI Edits

Coding Q&A: To date, there has been no guidance on implementing the new CPT code for OCTA.

Retinal Physician January 1, 2026 Vol 23, Issue January 2026 Page(s): 24

Clinical Report: OCTA Documentation, Frequency, and NCCI Edits

Overview

This report discusses the upcoming implementation of the new CPT code for optical coherence tomography angiography (OCTA) and the associated documentation and frequency guidelines. It highlights the importance of medical necessity and proper documentation to avoid denials and ensure appropriate utilization.

Background

The introduction of CPT code 92137 for OCTA on January 1, 2025, marks a significant advancement in retinal imaging. However, the lack of clear guidelines for its use and documentation poses challenges for healthcare providers. Understanding the coding and billing implications is crucial for optimizing patient care and minimizing reimbursement issues.

Data Highlights

No numerical data available in the source material.

Key Findings

Rephrase findings for clarity and ensure they are directly supported by the source material.

Clinical Implications

Healthcare providers must ensure that the use of OCTA is well-documented and justified in the context of patient care. Regular training on coding and documentation practices is essential to prevent denials and ensure compliance with Medicare guidelines.

Conclusion

As OCTA becomes integrated into clinical practice, adherence to documentation standards and understanding coding implications will be vital for effective patient management and reimbursement.

PentaVision

Retinal Physician