Indocyanine Green Angiography — CPB 0111 | AETNA Coverage Update

Aetna modified CPB 0111 for indocyanine green angiography, effective March 19, 2026. Here's what billing teams need to know.

Aetna, a CVS Health company, updated its indocyanine green angiography coverage policy under CPB 0111 in the Aetna system. The two primary codes at stake are CPT 92240 (ICGA with interpretation and report) and CPT 92242 (combined fluorescein and ICG angiography). This policy covers a wide range of indications — from ophthalmic uses to intraoperative imaging in breast reconstruction and sentinel lymph node mapping — and the line between covered and experimental is sharper than it looks.

Quick-Reference Table

Aetna Indocyanine Green Angiography Coverage Criteria and Medical Necessity Requirements 2026

The core rule for ophthalmic ICGA billing is this: CPT 92240 and 92242 are only covered when ICGA is used as an adjunct to fluorescein angiography. ICGA alone, without fluorescein angiography as the primary study, does not meet medical necessity under this coverage policy.

Aetna covers ICGA for 11 specific ophthalmic conditions. The diagnosis must be documented in the chart, and the documentation must also include one of three supporting findings — an ill-defined sub-retinal neovascular membrane or suspicious membrane on prior fluorescein angiography, sub-retinal hemorrhage or hemorrhagic retinal pigment epithelium (no prior FA required in this case), or a retinal pigment epithelium that does not show a sub-retinal neovascular membrane on current fluorescein angiography.

That third criterion is worth reading twice. It means Aetna will cover ICGA even when fluorescein angiography is negative — but only if the chart documents why the negative FA result led the physician to order ICGA. The physician's note needs to close that loop. If it doesn't, you're looking at a claim denial.

For non-ophthalmic indications, Aetna takes a narrower view. Three surgical uses clear the medical necessity bar:

That breast reconstruction carve-out is a real reimbursement risk. Aetna explicitly states that intraoperative imaging of tissue perfusion is integral to the surgical procedure. Billing C9733 separately alongside CPT 19357, 19361, 19364, 19367, 19368, or 19369 will likely result in a denial. Don't expect prior authorization to solve that — the policy is categorical, not case-by-case.

Check your prior authorization requirements at the plan level. CPB 0111 sets clinical criteria, but individual Aetna plans may layer on prior auth requirements. Confirm before the procedure, not after.

Aetna Indocyanine Green Angiography Exclusions and Non-Covered Indications

Aetna's experimental and investigational list for ICGA is long — and growing. The policy explicitly states this is not an all-inclusive list, which means Aetna reserves the right to deny uses not covered here even if they're not named.

The excluded indications span multiple specialties. That breadth is the real issue. A colorectal surgeon using ICGA to evaluate anastomotic perfusion, a general surgeon using it during esophagectomy, a bariatric surgeon using it intraoperatively — all of these are explicitly non-covered under this billing policy.

Some of these uses are gaining clinical traction. But Aetna's position is that the evidence isn't there yet. Billing for these will produce denials and may raise audit flags if the volume is high.

Coverage Indications at a Glance

Aetna Indocyanine Green Angiography Billing Guidelines and Action Items 2026

1. Update your charge capture for CPT 92240 and 92242 before March 19, 2026.
Both codes are covered only with a documented covered indication and only when ICGA is adjunct to fluorescein angiography. Set a charge capture review flag for any ICGA claim that doesn't pair with a fluorescein angiography service.

2. Build a documentation checklist for ophthalmic ICGA claims.
Every CPT 92240 or 92242 claim needs two things in the chart: the covered diagnosis (one of the 11 listed conditions) and one of the three supporting clinical findings. Train your ophthalmology providers on this now. Auditors look for the second piece — and it's frequently missing.

3. Do not bill HCPCS C9733 separately for breast reconstruction.
Aetna's coverage policy is explicit: intraoperative ICG imaging with the SPY Elite system is integral to the primary procedure. Billing C9733 separately alongside CPT 19357, 19361, 19364, 19367, 19368, or 19369 is a denial waiting to happen. Remove it from your charge capture for Aetna patients.

4. Flag ICGA billing from surgical specialties for review.
Colorectal, bariatric, esophageal, and robotic prostate procedures involving ICGA are all experimental under CPB 0111. If your facility bills across these specialties, pull a claim sample now. Any claims for ICGA in these contexts — under CPT 44140, 44160, 44205, 45110–45119, 43107–43124, 43286–43288, 55866, 55867, 43644, 43645, 43770–43775, or 43845–43848, 43886–43888 — are at high risk of denial.

5. Confirm sentinel lymph node mapping claims use CPT +38900 correctly.
ICG-based sentinel lymph node mapping in cervical cancer, endometrial cancer, and endometrial intraepithelial neoplasia is covered. CPT +38900 is the add-on code for intraoperative sentinel lymph node identification. Make sure it's linked to the correct primary procedure code and that the diagnosis code supports one of the three covered cancer types.

6. Talk to your compliance officer if your team bills ICGA across multiple specialties.
The experimental list in this policy is long, the excluded indications cross several service lines, and the effective date is March 19, 2026. If you're not sure how this applies to your mix of payers and procedures, get your compliance officer in the room before that date.

CPT, HCPCS, and ICD-10 Codes for Indocyanine Green Angiography Under CPB 0111

Covered CPT and HCPCS Codes (When Selection Criteria Are Met)

Other CPT Codes Related to CPB 0111

These codes appear in the context of covered or experimental indications. Coverage of the ICGA procedure itself depends on the specific indication — not the presence of these procedure codes.

Key ICD-10-CM Diagnosis Codes

The full CPB 0111 policy references 1,373 ICD-10-CM codes. The policy data includes the following confirmed code:

The full ICD-10-CM code list is available in the complete policy document at app.payerpolicy.org/p/aetna/0111. Pull that list and cross-reference it against your EHR diagnosis mapping before the effective date of March 19, 2026.