Summary & Overview
CPT 92242: Dual-Dye Ophthalmic Angiography with Interpretation
CPT code 92242 represents dual-dye ophthalmic angiography: a diagnostic imaging procedure using two intravenous dyes to visualize retinal and choroidal blood vessels, with interpretation and report. This modality is used to evaluate vascular and optic nerve disorders, detect intraocular tumors, and plan certain laser therapies. Nationally, the code matters because it supports management of sight-threatening conditions where detailed vascular imaging guides diagnosis and treatment decisions.
Key payers covered in this summary include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context, coding and service-line characterization, and guidance on where this procedure is typically performed. The publication provides benchmarks and policy-relevant insights about utilization and coding practice, clinical indications for use, and payer coverage considerations where available.
The piece is designed to help revenue cycle staff, clinicians, and policy analysts understand the clinical role of CPT code 92242, common billing environments, and the administrative context affecting reimbursement and prior authorization. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 92242 describes a diagnostic ophthalmic angiography procedure in which two distinct fluorescent dyes are injected into one or both eyes and rapid-sequence photographic images are captured to highlight the retinal and choroidal blood vessels. The provider interprets the dynamic imaging frames and prepares a diagnostic report. Indications include disorders of the ocular vessels and optic nerve, intraocular tumors, and preparation for certain laser treatments.
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Service type: Diagnostic ophthalmic angiography with dual-dye injection and interpretation
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Typical site of service: Hospital outpatient department or ambulatory surgical/eye clinic with imaging capabilities
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with a history of diabetes and progressive visual disturbance is referred to a retinal specialist for evaluation of suspected diabetic retinopathy with possible macular edema. The patient presents to an outpatient ophthalmology clinic equipped with retinal imaging. After dilation and topical anesthesia as needed, the provider performs a dual-dye angiographic study, injecting fluorescein and indocyanine green intravenously while capturing timed rapid-sequence fundus photographs. The procedure documents retinal and choroidal vascular perfusion, identifies areas of leakage, neovascularization, or tumor vascularity, and guides treatment planning such as focal/grid laser or intravitreal injections. The interpreting physician reviews the image sequence, documents findings, provides diagnostic interpretation, and generates a signed report included in the medical record. Typical workflow steps include patient consent and allergy review, pupil dilation, IV access placement, sequential dye injections with imaging capture, post-procedure monitoring for adverse reactions, interpretation, and report generation. Typical sites of service are outpatient ophthalmology clinics, hospital outpatient departments, and ambulatory surgery centers when performed in conjunction with other procedures.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When reporting only the physician’s interpretation and report separate from technical imaging services |