Retinal PhysicianOCTA Documentation, Frequency, and NCCI Edits

CPT code 92137 for OCTA launched January 1, 2025 with no MAC guidance on documentation, medical necessity, or frequency. Practices billing OCTA face active denial risk and cannot unbundle OCTA from retinal OCT or optic nerve OCT using any modifier.

Professional Impact

• OCTA bundled with retinal OCT, optic nerve OCT, FA, and ICG effective October 1, 2025; modifier unbundling available for some pairings but requires airtight medical necessity documentation
• Monthly OCTA is defensible only during active treatment; stable or minimally changing disease billed monthly will face medical necessity challenges
• Cloned or copy-pasted interpretations trigger denials; each report must document how that day’s OCTA findings specifically influenced the treatment decision
• Whether October 2025 NCCI edits were implemented in error remains unresolved, leaving practices to assume compliance risk without confirmed policy intent

Action Items

• Audit current OCTA documentation to confirm medical necessity justification appears in each impression or plan
• Establish a standard order template specifying test, indication, and eye(s) for every OCTA ordered
• Review all same-day OCTA pairings with FA, ICG, and eye codes for modifier compliance before submitting claims
• Limit OCTA to once per month during active treatment and no more than every 2 months for stable patients

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