$147.03
92235 represents fluorescein angiography alone. Choose 92242 when the encounter includes both fluorescein and ICG angiography.
On this page
CMS RVU26D · Effective 2026-10-01
92242 Retinal angiography Medicare reimbursement rates in Kentucky
Reports combined fluorescein and indocyanine-green angiography to assess retinal and choroidal circulation in patients with suspected or known vascular disease. Compare 92242 office and facility rates across CMS payment localities in Kentucky.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 92242 in Kentucky?
Kentucky has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$302.50
1 of 1 localities have a supported rate.
Payment area: Kentucky
One mapped payment locality.
Facility setting
No supported rate
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Ophthalmic diagnostic testing
About 92242: Combined retinal dye angiography
Reports combined fluorescein and indocyanine-green angiography to assess retinal and choroidal circulation in patients with suspected or known vascular disease.
This service combines two dye-based imaging studies of the back of the eye. After dye is administered, images show blood flow through the retinal and choroidal vessels; fluorescein highlights retinal circulation, while indocyanine green helps assess the choroid. Ophthalmologists, often retina specialists, use the findings in evaluations such as retinal vascular disease or neovascular age-related macular degeneration. The service includes interpretation and a report and may be performed in an office or facility setting.
Report 92242 when both angiographic studies are performed for the encounter; use the appropriate single-study code when only one dye study is done. The code covers unilateral or bilateral imaging, so modifier 50 does not increase payment. Submit the global service without a component modifier, or report the interpretation with modifier 26 and the equipment-and-staff service with modifier TC. When multiple ophthalmology diagnostic procedures are reported, the multiple-procedure reduction applies to the technical component.
CMS billing rules for 92242
- Professional and technical components
- Diagnostic test with a professional component (modifier 26, interpretation) and a technical component (modifier TC, equipment and staff); billing without a modifier is the global service.
- Multiple procedures
- Ophthalmology diagnostic multiple procedure reduction applies to the technical component.
- Bilateral procedures
- The code is already priced as bilateral; modifier 50 does not increase payment.
Where the value comes from
- Work RVU0.93 · 9%
- Practice expense (office) RVU9.10 · 90%
- Malpractice RVU0.04 · 0%
28K
Medicare services in 2024 · #998 by national volume
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
92242 compared with similar codes
Office rates for Kentucky, from the same CMS release.
$221.21
92240 represents ICG angiography alone. Choose 92242 when fluorescein angiography is also performed.
$34.42
92250 is fundus photography, not dye-based angiography. It does not replace 92242 when both angiographic studies are performed.
Compare 92242 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Kentucky →
Office / nonfacility
$302.50
Facility
Unavailable
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 92242 in Kentucky.
PPRRVU2026_Oct_nonQPP.csv
11,719
- Code
- 92242
- Physician work
- 0.93
- Practice expense
- 9.10
- Malpractice
- 0.04
GPCI2026.csv
55
- Locality
- Kentucky
- Physician work
- 1.000
- Practice expense
- 0.889
- Malpractice
- 0.915
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.93 | × 1.000 | 0.9300 |
| Practice expense | 9.10 | × 0.889 | 8.0899 |
| Malpractice | 0.04 | × 0.915 | 0.0366 |
| Total RVUs | 9.0565 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Kentucky$302.50
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.93 | 1 |
| Practice expense | 9.1 | 0.889 |
| Malpractice | 0.04 | 0.915 |
(0.93 × 1 + 9.1 × 0.889 + 0.04 × 0.915) × $33.4009 = $302.50
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
92242 billing questions
When should 92242 be chosen instead of 92235 or 92240?
Use 92242 when both fluorescein and indocyanine-green angiography are performed. Use 92235 for a fluorescein-only study or 92240 for an ICG-only study.
Does 92242 cover one eye or both eyes?
It is priced as a unilateral-or-bilateral service. Modifier 50 does not increase payment.
How are the professional and technical portions reported?
Report the global service without a modifier. Use modifier 26 for the interpretation and report, or modifier TC for the equipment-and-staff portion when billing components separately.
Does the multiple-procedure reduction affect both components?
The ophthalmology diagnostic multiple-procedure reduction applies to the technical component.
What documentation supports reporting 92242?
Document that both dye studies were performed, the clinical reason for assessing retinal and choroidal circulation, the images obtained, and the interpreting clinician’s findings and report.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
11,71692240,,Icg angiography i&r uni/bi,A,,0.78,6.49,,6.49,NA,0.08,7.35,7.35,1,XXX,0.00,0.00,0.00,7,2,0,0,0,9,,33.4009,09,0,99,7.14,7.14,0.08
11,71792240,26,Icg angiography i&r uni/bi,A,,0.78,0.55,,0.55,,0.07,1.40,1.40,1,XXX,0.00,0.00,0.00,7,2,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
11,71892240,TC,Icg angiography i&r uni/bi,A,,0.00,5.94,,5.94,NA,0.01,5.95,5.95,1,XXX,0.00,0.00,0.00,7,2,0,0,0,9,,33.4009,02,0,99,6.59,6.59,0.01
11,71992242,,Fluorescein&icg angiography,A,,0.93,9.10,,9.10,NA,0.04,10.07,10.07,1,XXX,0.00,0.00,0.00,7,2,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
11,72092242,26,Fluorescein&icg angiography,A,,0.93,0.65,,0.65,,0.03,1.61,1.61,1,XXX,0.00,0.00,0.00,7,2,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
11,72192242,TC,Fluorescein&icg angiography,A,,0.00,8.45,,8.45,NA,0.01,8.46,8.46,1,XXX,0.00,0.00,0.00,7,2,0,0,0,9,,33.4009,02,0,99,0.00,0.00,0.00
11,72292250,,Fundus photography w/i&r,A,,0.39,0.70,,0.70,NA,0.02,1.11,1.11,1,XXX,0.00,0.00,0.00,7,2,0,0,0,9,,33.4009,09,0,99,4.20,4.20,0.09
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915
5607202,LA,01,NEW ORLEANS,1.000,0.941,1.136
5707202,LA,99,REST OF LOUISIANA,1.000,0.885,0.958
5814112,ME,03,SOUTHERN MAINE,1.000,0.991,0.631