With the Centers for Medicaid’s 2025 Medicare Fee Schedule now in play, eyecare practitioners (ECPs) should be aware of new changes in effect this year.
One major update for the eyecare community: A new current procedural terminology (CPT) code for optical coherence tomography angiography (OCTA).
Let’s start with the basics …
Which comes down to: OCTA, a noninvasive imaging technique that’s used to visualize and examine the retinal structure and blood vessels in the posterior segment—without the need for dye injection—while rapidly generating volumetric angiography images.
It’s been 10 years since the first OCTA instrument—ZEISS’s AngioPlex, which received FDA 510(k) clearance in September 2015—was introduced to the U.S. commercial market.
- And since then: In May 2024, the FDA approved an updated ZEISS CIRRUS 6000 OCTA with increased features.
With this approval, the American Medical Association (AMA) assigned the coding for OCTA to be exactly the same as the already-established coding for OCT (92134, in case you were wondering).
That doesn’t sound too complicated.
It doesn’t, does it? However, following that initial updated CPT code designation, the family of Category I OCT codes expanded to include:
- 92132
- What this applies to: Computerized ophthalmic diagnostic imaging (OCT, anterior segment with interpretation and report, unilateral and bilateral)
- 92133
- What this applies to: Computerized ophthalmic diagnostic imaging (OCT, posterior segment, with interpretation and report, unilateral and bilateral; optic nerve)
- 92134
- What this applies to: Retina
Note: The descriptors for each code listed above include the most up-to-date versions (as of Jan. 1, 2025).
Real quick: What does this Category I designation mean?
With new codes released on an annual basis by the AMA, the first of three CPT categories is reserved for the billing purposes of standard medical devices and procedures considered to be established and widely used.
Comparatively:
- Category II refers to supplemental tracking codes (released on a bi-annual basis)
- Category III applies to temporary codes for emerging technologies or procedures still under evaluation (released three times a year).
And what criteria must be met for a Category I code to be established?
For both a new or revised code, a medical device or procedure must:
- Be FDA-approved or cleared for the use of specific devices or drugs
- Already be in use by many qualified physicians across the United States
- Already be in use (or performed) with frequency consistent with its intended clinical use
- Be consistent with current medical practice
- Have well-documented clinical efficacy in peer-reviewed literature
Gotcha. So what is this new OCTA CPT code?
The new Category I OCTA-specific CPT code is 92137.
Why it was established: To describe computerized ophthalmic imaging of the retina in a way that’s a more accurate representation of the service performed.
When using: The code requires both traditional OCT of the retina and OCTA to be performed and interpreted with a report on the same day.
- To note: The OCTA code cannot be billed at the same patient encounter as two other OCT codes (92133 or 92134).
Any other billing notes?
OCTA can be reported separately when performed during the same visit as the following:
- Fluorescein angiography (FA; 92235)
- Indocyanine-green angiography (ICG; 92240)
- Combined FA-ICG angiography (92242)
When does (did?) this new code go into effect?
Jan. 1, 2025.
And how does this compare to its previous billing process?
Prior to Jan. 1, OCTA was billed along with the OCT CPT code (92134).
Now to reimbursement: How does it stack up against similar codes?
As the American Academy of Ophthalmology (AAO) noted, the type of testing this OCTA code is used for determines how much (or how little) the reimbursement amount will be compared to the pre-existing OCT and FA CPT codes.
Compared to 92134 (OCT of retina): More pay for 92137 (OCTA of retina)
- The details: The OCTA code has been assigned a greater total of relative value units (RVUs) as well as a higher Medicare Physician Fee Schedule (MPFS) payment
- Note: RVUs are a way to measure the value of calculating physician reimbursements.
- Why: To account for “the additional work component and practice expenses associated with performing and interpreting OCTA.”
Compared to 92235 (FA): Less pay for 92137 (OCTA of retina)
- The details: Payment for OCTA is less than FA
- Why: FA “involves more work and requires additional supplies, resources, and different testing.”
Let’s talk specifics on this.
The AAO broke these three codes down by their 2025 total RVU and MPFS national averages:
- 92134 (OCT of retina)
- 2025 total RVU: 0.97
- 2025 MPFS national average: $31.38
- 92137 (OCTA of retina)
- 2025 total RVU: 1.76
- 2025 MPFS national average: $56.93
- 92235 (FA)
- 2025 total RVU: 4.72
- 2025 MPFS national average: $152.68
For reference: The MPFS national average values were based on a conversion factor of $32.3465.
Interesting … so how are physicians reacting to this?
We checked in with a few ECPs for their perspective on how—and if, so far, at least— this new OCTA code will improve the reimbursement process (as is the intent).
Daniel Epshtein, OD, FAAO, an assistant professor in the ophthalmology department at Mount Sinai Morningside in New York City, New York, shared his feedback.
“I have been using OCTA for years without billing for it because I always want to do what’s best for the patient,” Dr. Epshtein, told Glance. “With the new OCTA code, I will now bill for services that I was previously providing without reimbursement.”
And for other clinical practices already using OCTA?
In addition to this new billing capability, Dr. Epshtein said the creation of the code represents positive change for practices that have already invested in OCTA as well as a positive impact for those who have yet to.
“I’m more excited about how this new code will hopefully bring about the widespread adoption of OCTA in clinical practice,” he said, “so that we can all increase the standard of care for our patients.”
*Disclaimer: The information provided in this article does not and is not intended to constitute legal advice; instead, all information, content, materials available herein are for general information purposes only.