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Retinal Physician

Article

OCTA Documentation, Frequency, and NCCI Edits

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

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

Clinical Scorecard: OCTA Documentation, Frequency, and NCCI Edits

At a Glance

CategoryDetail
ConditionOptical Coherence Tomography Angiography (OCTA)
Key MechanismsUtilization for monitoring and treatment decision-making in retinal diseases.
Target PopulationPatients undergoing treatment for retinal conditions requiring imaging.
Care SettingRetina practices and ophthalmology clinics.

Key Highlights

  • New CPT code for OCTA (92137) effective January 1, 2025.
  • OCTA is categorized under SCODI with retinal OCT (92134) by MACs.
  • Medical necessity must be documented for OCTA use.
  • Routine monthly OCTA in stable conditions should be approached with caution.
  • NCCI edits bundle OCTA with other imaging codes, requiring careful documentation.

Guideline-Based Recommendations

Diagnosis

  • Document the medical necessity of OCTA in the treatment plan.

Management

  • Use OCTA once per month during active treatment; every 2 months if not active.

Monitoring & Follow-up

  • Ensure clinical changes justify OCTA imaging frequency.

Risks

  • Denials may occur due to lack of medical necessity or supporting documentation.

Patient & Prescribing Data

Patients with retinal diseases requiring imaging.

OCTA should be justified and documented to avoid denials.

Clinical Best Practices

  • Include relevant findings from both OCTA and retinal OCT in reports.
  • Store images in the record or image repository.
  • Specify the exact test, indication, and eye(s) in the order.

References