**Abstract:**  
  
 _Fluorescein_  
  
Fluorescein angiography is used in the diagnosis and treatment of a wide range
of ocular disorders. Its visible fluorescence on leaking from damaged vessels
makes it particularly useful in the diagnosis of retinal vascular disorders
and monitoring treatment of conditions amenable to laser photocoagulation.  
  
The dye is injected intravenously and serial photographs are taken through the
pupil. While morphological characteristics alone may be pathognomonic of
certain disease states, the timing of appearance of the dye in the choroid, in
the central retinal artery and in the filling (or otherwise) of the quadrants
have diagnostic implications.  
  
 _Indocyanine Green_  
  
Indocyanine green dye is injected intravenously into the patient to highlight
the vessels in the retina and the deeper tissue layer of the choroid. Under
infrared light, Indocyanine Green fluoresces allowing the choroidal vessels to
be visualized through the retinal pigment epithelium or in the presence of
retinal or vitreous hemorrhage that would otherwise obscure visualization.
Indocyanine green angiography (ICG) is effective in the diagnosis and
treatment of ill-defined choroidal neovascularization (e.g., associated with
age related macular degeneration). It is also useful in the evalution of
feeder vessels, choroidal leakages in the late phase, and ruptures of the
pigment epithelium.  
  
 **Indications:**  
  
 _Fluorescein_  
  
Fluorescein angiography with interpretation is medically necessary as an
adjunct to the diagnosis of chorioretinal vascular abnormalities especially
relating to choroid neovascularization, noninfective vasculitis, and age
related macular degeneration. It may also be appropriate in evaluating
intraocular tumors, visual loss in systemic disease, acute exudative
inflammations such as toxoplasmosis and optic disc edema. Medical necessity
for such angiography would generally be in the context of a changing clinical
picture. Fluorescein angiography may be useful in diabetic retinopathy in
identifying ischemia and neovascularization, locating microaneurysms, and
defining macular edema.  
  
Fluorescein angiography following treatment, for example, of choroidal
neovascularization (CNV) is necessary to monitor for recurrence or to detect
additional treatable disease. Usually this is performed on the basis of a
change in the clinical picture similar to the way it is employed prior to
treatment. However, fluorescein angiography may be performed following
treatment without clinical change in order to detect occult lesions. This will
occur most often in CNV and very rarely in other diseases.  
  
_Indocyanine Green_  
  
Indocyanine green angiography (ICG) may be a valuable diagnostic adjunct to
fluorescein angiography in the evaluation of the following conditions:

  * Retinal neovascularization
  * Choroid neovascularization
  * Serous detachment of retinal pigment epithelium
  * Hemorrhagic detachment of retinal pigment epithelium
  * Retinal hemorrhage

**Limitations:**  
  
 _Fluorescein_  
  
Studies performed for screening will be denied by Medicare as not medically
necessary.  
  
Fluorescein angiography must be performed under the direct supervision
(physician present in the office and immediately available) of a physician
when done by a non-physician practitioner.  
  
If excluded by State law, optometrists may not be reimbursed for fluorescein
angiography.  
  
Fluorescein angiography of an asymptomatic contralateral eye without new
abnormalities on ophthalmoscopic exam, in patients with unilateral Age related
Macular Degeneration (AMD) or other disease, will be denied as not medically
necessary. Evidence of medical necessity must be documented in the medical
record for each eye.  
  
 _Indocyanine Green_  
  
Indocyanine green angiography must be performed under the direct supervision
(physician present in the office and immediately available) of a physician
when done by a non-physician practitioner.  
  
If excluded by State law, optometrists may not be reimbursed for ICG
angiography.  
  
Indocyanine green is formulated with iodine and should not be used on patients
who are allergic to iodine.  
  
ICG for the evaluation of patients with background diabetic retinopathy is not
considered to be a medically necessary service.  
  
ICG angiography of an asymptomatic contralateral eye without new abnormalities
on ophthalmoscopic exam, in patients with unilateral AMD or other disease,
will be denied as not medically necessary. Evidence of medical necessity must
be documented in the medical record for each eye.  
  
Studies performed for screening will be denied by Medicare as not medically
necessary.  
  
 ** **