Coding and CPT inclusion disclaimer

CPT 92235 (Fluorescein angiography with interpretation and report) is the referenced procedure code for this clinical policy. Inclusion or exclusion of any codes does not guarantee coverage; providers should reference the most current CPT coding guidance and payer billing rules prior to claim submission.

• Affected CPT: 92235 — Fluorescein angiography (includes multi-frame imaging) with interpretation and report

Diagnosis codes (supporting coverage)

The policy lists ICD-10-CM diagnosis codes that support medical necessity for fluorescein angiography. Use an appropriate, specific diagnosis code that reflects the patient’s retinal condition when requesting authorization or submitting claims.

• Examples of supporting diagnoses (non-exhaustive): E10.3313, E10.3391–E10.3493, E10.3411–E10.3522 (various diabetic retinopathy codes)
• Select the most specific laterality and complication code available

Prior authorization note

Providers must follow Health Plan-level administrative policies for prior authorization if applicable. The clinical criteria define medical necessity, but prior authorization requirements (where required by the plan) are determined by the payer’s administrative processes.

• Confirm whether Arizona Complete Health requires prior authorization for CPT 92235 before scheduling the procedure
• If prior authorization is required, submit clinical documentation demonstrating how the member meets the medical necessity criteria in this policy

No authorization or denial triggers stated

This section lists diagnoses and clinical indications that support coverage only; it does not create automatic authorization or denial triggers. Authorization or denial decisions are based on a combination of submitted clinical documentation, payer-specific administrative requirements, and any applicable coverage rules.

• Provide clinical notes, ophthalmoscopy findings, imaging, and any prior treatment details to support medical necessity
• Do not assume a listed ICD-10 code alone will result in approval

Payer-specific precedence

Payer-specific and program-specific coverage provisions take precedence where applicable. For Medicaid members, state Medicaid coverage provisions override this clinical policy when there is a conflict. For Medicare members, applicable National Coverage Determinations (NCDs), Local Coverage Determinations (LCDs), and Medicare Coverage Articles should be reviewed and applied.

• Medicaid: follow the state Medicaid manual for any coverage provisions that pertain to fluorescein angiography
• Medicare: review applicable NCDs, LCDs, and Medicare Coverage Articles on the CMS website prior to applying this policy

Required cross-checks with public coverage determinations

Providers should cross-check requests against public coverage determinations and payer guidance before submitting. Ensure consistency with NCDs, LCDs, Medicare Coverage Articles, and applicable state Medicaid manuals to avoid denials or delays.

• Review CMS (https://www.cms.gov) for NCDs, LCDs, and Coverage Articles relevant to fluorescein angiography
• Check the state Medicaid manual for Medicaid members and Arizona Complete Health administrative policy for plan-specific rules