Indocyanine Green Angiography — CPB 0111 | AETNA Coverage Update

TL;DR: Aetna, a CVS Health company, modified CPB 0111 governing indocyanine green angiography coverage, effective September 26, 2025. If your practice bills CPT 92240 or 92242, review your documentation requirements now.

Aetna's updated indocyanine green angiography coverage policy under CPB 0111 Aetna system touches a wider set of specialties than most billing teams realize. The policy covers ophthalmic ICGA via CPT 92240 and 92242, intraoperative ICGA for neurosurgery, near-infrared angiography via HCPCS C9733 for breast reconstruction, and sentinel lymph node mapping with ICG for gynecologic oncology. Each indication carries its own documentation requirements, and the gaps between them are where claim denials happen.

---

Quick-Reference Table

Field	Detail Copy
Payer	Aetna, a CVS Health company
Policy	Indocyanine Green Angiography — CPB 0111
Policy Code	CPB 0111
Change Type	Modified
Effective Date	September 26, 2025
Impact Level	High
Specialties Affected	Ophthalmology, Retinal Surgery, Neurosurgery, Plastic/Reconstructive Surgery, Gynecologic Oncology
Key Action	Audit documentation for CPT 92240 and 92242 to confirm the three-prong fluorescein angiography note requirement is in the chart before billing

---

Aetna Indocyanine Green Angiography Coverage Criteria and Medical Necessity Requirements 2025

The core of this Aetna indocyanine green angiography coverage policy is straightforward: ICGA is medically necessary when used as an adjunct to fluorescein angiography, not as a standalone test. That word "adjunct" is doing a lot of work, and missing it is the fastest path to a denial.

For the ophthalmic indications, Aetna covers CPT 92240 (indocyanine green angiography with interpretation and report) and CPT 92242 (combined fluorescein and indocyanine green angiography) across 11 specific retinal and choroidal conditions. The covered conditions include exudative senile macular degeneration, retinal neovascularization, serous and hemorrhagic detachment of retinal pigment epithelium, choroidal hemangioma, occlusive retinal vasculitis, birdshot chorioretinitis, foveomacular vitelliform dystrophy (Best disease), multiple evanescent white dot syndrome (MEWDS), retinal hemorrhage, and acute posterior multi-focal placoid pigment epitheliopathy.

Medical necessity alone is not enough. The physician's documentation must also support one of three specific clinical findings. First: evidence of an ill-defined sub-retinal neovascular membrane or suspicious membrane on a previous fluorescein angiography. Second: presence of sub-retinal hemorrhage or hemorrhagic retinal pigment epithelium — and here Aetna explicitly states that a prior fluorescein angiography is not required for this finding. Third: the retinal pigment epithelium does not show a sub-retinal neovascular membrane on a current fluorescein angiography. Your documentation must check one of those three boxes, clearly, or expect a denial.

The policy also covers ICGA in three non-ophthalmic settings. Intraoperative ICGA for intracranial aneurysm surgery is medically necessary. Near-infrared angiography with ICG using a system like the SPY Elite (billed as HCPCS C9733) is covered for breast reconstruction surgery — but Aetna treats this as integral to the primary surgical procedure and will not separately reimburse it. Finally, ICG for sentinel lymph node mapping is covered for cervical cancer, endometrial cancer, and endometrial intraepithelial neoplasia, billed with CPT add-on code +38900.

The policy does not list specific prior authorization requirements within the CPB itself. That does not mean prior auth is off the table. Check the member's plan and your Aetna contract before scheduling — prior authorization requirements vary by plan type, and retinal imaging procedures are commonly subject to utilization management review.

---

Aetna Indocyanine Green Angiography Exclusions and Non-Covered Indications

Aetna draws a clear line on non-ocular surgical use. ICGA used during any surgery other than the specifically listed indications is considered incidental to the surgery and will not be separately reimbursed. This covers a wide range of procedures in the "related codes" list — esophagectomies, colectomies, gastric procedures, pancreatectomies, prostatectomies — where ICG is sometimes used intraoperatively to assess perfusion or anatomy.

Similarly, near-infrared angiography with ICG for breast reconstruction (C9733) is covered but explicitly not separately reimbursable. If your reconstructive surgery team is billing C9733 as a standalone line item alongside CPT codes like 19364 or 19367, those claims are at high risk for denial. The imaging is bundled.

The policy does not call out specific "experimental" designations for any of the listed indications. But any use of CPT 92240 or 92242 outside the 11 named ophthalmic conditions — without the required fluorescein angiography documentation — will not meet medical necessity under this policy.

---

Coverage Indications at a Glance

---

Aetna Indocyanine Green Angiography Billing Guidelines and Action Items 2025

These steps apply to any practice billing CPT 92240, 92242, HCPCS C9733, or CPT +38900 for Aetna members after September 26, 2025.

Copy Action Items

---

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

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

Code	Type	Description Copy
92240	CPT	Indocyanine-green angiography (includes multi-frame imaging) with interpretation and report
92242	CPT	Fluorescein angiography and indocyanine-green angiography (includes multiframe imaging) performed at the same session
C9733	HCPCS	Non-ophthalmic fluorescent vascular angiography (e.g., SPY Elite System) — covered for breast reconstruction; not separately reimbursed

Other CPT Codes Related to CPB 0111 (Context Codes — Not Separately Payable for ICGA)

These codes represent the primary procedures where ICGA may be used. Aetna considers ICGA incidental or integral for these procedures. Do not add a separate ICGA line to claims billed under these codes.

Flap and Reconstructive Surgery

Breast Reconstruction

Cranial and Vascular Surgery

Sentinel Lymph Node Mapping

Code	Type	Description Copy
+38900	CPT	Intraoperative identification (mapping) of sentinel lymph node(s) — includes injection of non-radioactive dye, add-on code

Esophageal Surgery

Gastric and Bariatric Surgery

Colorectal Surgery

Pancreatic Surgery

Code	Type	Description Copy
48150–48154	CPT	Pancreatectomy, proximal subtotal (Whipple and variants)

Urologic Surgery

Other HCPCS Codes Related to CPB 0111

The bevacizumab codes appear here because anti-VEGF injections are frequently used in the same patient population and clinical context — particularly in exudative macular degeneration and retinal neovascularization. They are not covered under the ICGA indication. They have their own coverage criteria.

Key ICD-10-CM Codes

The policy links to 1,373 ICD-10-CM codes. Your coding team should map each claim to a diagnosis within Aetna's covered list. Common categories include codes for macular degeneration (H35.30–H35.32 range), retinal detachment and defects, chorioretinal disorders, retinal vascular occlusions, and retinal hemorrhage. Run a crosscheck against your current active diagnosis list for retinal patients before September 26, 2025.

---