The full field electroretinogram (ERG) is used to detect loss of retinal function or distinguish between retinal and optic nerve lesions. ERG measures the electrical activity generated by neural and non-neuronal cells in the retina in response to a light stimulus.
The focal or foveal ERG (fERG) is useful in providing information regarding diseases limited to the macula.
Multi-focal electroretinography (mfERG) is a higher resolution form of ERG, enabling assessment of ERG activity in small areas of the retina.
Pattern ERG (PERG) uses pattern-reversal stimuli and is used to detect subtle optic neuropathies.
Electroretinography used to diagnose loss of retinal function or distinguish between retinal lesions and optic nerve lesions may be considered medically necessary for ANY ONE of the following indications (This is not an all-inclusive list):
All other indications for electroretinography not listed above, except glaucoma are considered not medically necessary.
0509T |
92273 | 92274 |
mfERG may be considered medically necessary to detect chloroquine (Aralen) and hydroxychloroquine (Plaquenil) toxicity.
92274 |
ERG (all forms: ERG, fERG, mfERG, PERG, etc.) for glaucoma is considered experimental/investigational and therefore non-covered, due to lack of scientific based evidence available in the current published peer reviewed literature.
0509T |
92273 | 92274 |
Covered Diagnosis Codes for Procedure Codes 0509T, 92273 and 92274
A18.53 | D18.09 | E08.311 | E08.319 | E08.3211 | E08.3212 | E08.3213 |
E08.3291 | E08.3292 | E08.3293 | E08.3311 | E08.3312 | E08.3313 | E08.3391 |
E08.3392 | E08.3393 | E08.3411 | E08.3412 | E08.3413 | E08.3491 | E08.3492 |
E08.3493 | E08.3511 | E08.3512 | E08.3513 | E08.3521 | E08.3522 | E08.3523 |
E08.3531 | E08.3532 | E08.3533 | E08.3541 | E08.3542 | E08.3543 | E08.3551 |
E08.3552 | E08.3553 | E08.3591 | E08.3592 | E08.3593 | E09.311 | E09.319 |
E09.3211 | E09.3212 | E09.3213 | E09.3291 | E09.3292 | E09.3293 | E09.3311 |
E09.3312 | E09.3313 | E09.3391 | E09.3392 | E09.3393 | E09.3411 | E09.3412 |
E09.3413 | E09.3491 | E09.3492 | E09.3493 | E09.3511 | E09.3512 | E09.3513 |
E09.3521 | E09.3522 | E09.3523 | E09.3531 | E09.3532 | E09.3533 | E09.3541 |
E09.3542 | E09.3543 | E09.3551 | E09.3552 | E09.3553 | E09.3591 | E09.3592 |
E09.3593 | E10.311 | E10.319 | E10.3211 | E10.3212 | E10.3213 | E10.3291 |
E10.3292 | E10.3293 | E10.3311 | E10.3312 | E10.3313 | E10.3391 | E10.3392 |
E10.3393 | E10.3411 | E10.3412 | E10.3413 | E10.3491 | E10.3492 | E10.3493 |
E10.3511 | E10.3512 | E10.3513 | E10.3521 | E10.3522 | E10.3523 | E10.3531 |
E10.3532 | E10.3533 | E10.3541 | E10.3542 | E10.3543 | E10.3551 | E10.3552 |
E10.3553 | E10.3591 | E10.3592 | E10.3593 | E11.311 | E11.319 | E11.3211 |
E11.3212 | E11.3213 | E11.3291 | E11.3292 | E11.3293 | E11.3311 | E11.3312 |
E11.3313 | E11.3391 | E11.3392 | E11.3393 | E11.3411 | E11.3412 | E11.3413 |
E11.3491 | E11.3492 | E11.3493 | E11.3511 | E11.3512 | E11.3513 | E11.3521 |
E11.3522 | E11.3523 | E11.3531 | E11.3532 | E11.3533 | E11.3541 | E11.3542 |
E11.3543 | E11.3551 | E11.3552 | E11.3553 | E11.3591 | E11.3592 | E11.3593 |
E13.311 | E13.319 | E13.3211 | E13.3212 | E13.3213 | E13.3291 | E13.3292 |
E13.3293 | E13.3311 | E13.3312 | E13.3313 | E13.3391 | E13.3392 | E13.3393 |
E13.3411 | E13.3412 | E13.3413 | E13.3491 | E13.3492 | E13.3493 | E13.3511 |
E13.3512 | E13.3513 | E13.3521 | E13.3522 | E13.3523 | E13.3531 | E13.3532 |
E13.3533 | E13.3541 | E13.3542 | E13.3543 | E13.3551 | E13.3552 | E13.3553 |
E13.3591 | E13.3592 | E13.3593 | E50.5 | E50.9 | F44.6 | G45.3 |
H15.031 | H15.032 | H15.033 | H20.011 | H20.012 | H20.013 | H30.001 |
H30.002 | H30.003 | H30.011 | H30.012 | H30.013 | H30.021 | H30.022 |
H30.023 | H30.031 | H30.032 | H30.033 | H30.041 | H30.042 | H30.043 |
H30.101 | H30.102 | H30.103 | H30.111 | H30.112 | H30.113 | H30.121 |
H30.122 | H30.123 | H30.131 | H30.132 | H30.133 | H30.141 | H30.142 |
H30.143 | H30.21 | H30.22 | H30.23 | H30.811 | H30.812 | H30.813 |
H30.891 | H30.892 | H30.893 | H30.91 | H30.92 | H30.93 | H31.001 |
H31.002 | H31.003 | H31.011 | H31.012 | H31.013 | H31.021 | H31.022 |
H31.023 | H31.091 | H31.092 | H31.093 | H31.101 | H31.102 | H31.103 |
H31.111 | H31.112 | H31.113 | H31.121 | H31.122 | H31.123 | H31.20 |
H31.21 | H31.22 | H31.23 | H31.29 | H31.301 | H31.302 | H31.303 |
H31.311 | H31.312 | H31.313 | H31.321 | H31.322 | H31.323 | H31.401 |
H31.402 | H31.403 | H31.411 | H31.412 | H31.413 | H31.421 | H31.422 |
H31.423 | H33.001 | H33.002 | H33.003 | H33.011 | H33.012 | H33.013 |
H33.021 | H33.022 | H33.023 | H33.031 | H33.032 | H33.033 | H33.041 |
H33.042 | H33.043 | H33.051 | H33.052 | H33.053 | H33.101 | H33.102 |
H33.103 | H33.111 | H33.112 | H33.113 | H33.191 | H33.192 | H33.193 |
H33.21 | H33.22 | H33.23 | H33.301 | H33.302 | H33.303 | H33.311 |
H33.312 | H33.313 | H33.321 | H33.322 | H33.323 | H33.331 | H33.332 |
H33.333 | H33.41 | H33.42 | H33.43 | H33.8 | H34.01 | H34.02 |
H34.03 | H34.11 | H34.12 | H34.13 | H34.211 | H34.212 | H34.213 |
H34.231 | H34.232 | H34.233 | H34.8110 | H34.8111 | H34.8112 | H34.8120 |
H34.8121 | H34.8122 | H34.8130 | H34.8131 | H34.8132 | H34.821 | H34.822 |
H34.823 | H34.8310 | H34.8311 | H34.8312 | H34.8320 | H34.8321 | H34.8322 |
H34.8330 | H34.8331 | H34.8332 | H34.9 | H35.00 | H35.012 | H35.013 |
H35.021 | H35.022 | H35.023 | H35.031 | H35.032 | H35.033 | H35.041 |
H35.042 | H35.043 | H35.051 | H35.052 | H35.053 | H35.061 | H35.062 |
H35.063 | H35.071 | H35.072 | H35.073 | H35.09 | H35.101 | H35.102 |
H35.103 | H35.111 | H35.112 | H35.113 | H35.121 | H35.122 | H35.123 |
H35.131 | H35.132 | H35.133 | H35.141 | H35.142 | H35.143 | H35.151 |
H35.152 | H35.153 | H35.161 | H35.162 | H35.163 | H35.171 | H35.172 |
H35.173 | H35.21 | H35.22 | H35.23 | H35.30 | H35.311 | H35.3110 |
H35.3111 | H35.3112 | H35.3113 | H35.3114 | H35.3120 | H35.3121 | H35.3122 |
H35.3123 | H35.3124 | H35.3130 | H35.3131 | H35.3132 | H35.3133 | H35.3134 |
H35.3210 | H35.3211 | H35.3212 | H35.3213 | H35.3220 | H35.3221 | H35.3222 |
H35.3223 | H35.3230 | H35.3231 | H35.3232 | H35.3233 | H35.33 | H35.341 |
H35.342 | H35.343 | H35.351 | H35.352 | H35.353 | H35.361 | H35.362 |
H35.363 | H35.371 | H35.372 | H35.373 | H35.381 | H35.382 | H35.383 |
H35.40 | H35.411 | H35.412 | H35.413 | H35.421 | H35.422 | H35.423 |
H35.431 | H35.432 | H35.433 | H35.441 | H35.442 | H35.443 | H35.451 |
H35.452 | H35.453 | H35.461 | H35.462 | H35.463 | H35.50 | H35.51 |
H35.52 | H35.53 | H35.54 | H35.61 | H35.62 | H35.63 | H35.70 |
H35.711 | H35.712 | H35.713 | H35.721 | H35.722 | H35.723 | H35.731 |
H35.732 | H35.733 | H35.81 | H35.82 | H35.89 | H36 | H44.2A1 |
H44.2A2 | H44.2A3 | H44.2B1 | H44.2B2 | H44.2B3 | H44.2C1 | H44.2C2 |
H44.2C3 | H44.2D1 | H44.2D2 | H44.2D3 | H44.2E1 | H44.2E2 | H44.2E3 |
H46.01 | H46.02 | H46.03 | H46.11 | H46.12 | H46.13 | H46.2 |
H46.3 | H46.8 | H46.9 | H47.011 | H47.012 | H47.013 | H47.021 |
H47.022 | H47.023 | H47.031 | H47.032 | H47.033 | H47.091 | H47.092 |
H47.093 | H47.10 | H47.11 | H47.12 | H47.13 | H47.141 | H47.142 |
H47.143 | H47.20 | H47.211 | H47.212 | H47.213 | H47.22 | H47.231 |
H47.232 | H47.233 | H47.291 | H47.292 | H47.293 | H47.311 | H47.312 |
H47.313 | H47.321 | H47.322 | H47.323 | H47.331 | H47.332 | H47.333 |
H47.391 | H47.392 | H47.393 | H53.10 | H53.11 | H53.121 | H53.122 |
H53.123 | H53.131 | H53.132 | H53.133 | H53.15 | H53.16 | H53.19 |
H53.411 | H53.412 | H53.413 | H53.451 | H53.452 | H53.453 | H53.51 |
H53.52 | H53.60 | H53.61 | H53.62 | H53.63 | H53.69 | H53.71 |
H53.72 | H53.8 | H53.9 | H54.0X33 | H54.0X34 | H54.0X35 | H54.0X43 |
H54.0X44 | H54.0X45 | H54.0X53 | H54.0X54 | H54.0X55 | H54.1131 | H54.1132 |
H54.1141 | H54.1142 | H54.1151 | H54.1152 | H54.1213 | H54.1214 | H54.1215 |
H54.1223 | H54.1224 | H54.1225 | H54.2X11 | H54.2X12 | H54.2X21 | H54.2X22 |
H54.413A | H54.414A | H54.415A | H54.42A3 | H54.42A4 | H54.42A5 | H54.511A |
H54.512A | H54.52A1 | H54.52A2 | H54.7 | S04.011A | S04.011D | S04.011S |
S04.012A | S04.012D | S04.012S | S05.51XA | S05.51XD | S05.51XS | S05.52XA |
S05.52XD | S05.52XS |
Non-Covered Diagnosis Codes for Procedure Codes 0509T, 92273 and 92274
H40.10X0 | H40.10X1 | H40.10X2 | H40.10X3 | H40.10X4 | H40.1110 | H40.1111 |
H40.1112 | H40.1113 | H40.1114 | H40.1120 | H40.1121 | H40.1122 | H40.1123 |
H40.1124 | H40.1130 | H40.1131 | H40.1132 | H40.1133 | H40.1134 | H40.1190 |
H40.1191 | H40.1192 | H40.1193 | H40.1194 | H40.1210 | H40.1211 | H40.1212 |
H40.1213 | H40.1214 | H40.1220 | H40.1221 | H40.1222 | H40.1223 | H40.1224 |
H40.1230 | H40.1231 | H40.1232 | H40.1234 | H40.1290 | H40.1291 | H40.1292 |
H40.1293 | H40.1294 | H40.1310 | H40.1311 | H40.1312 | H40.1313 | H40.1314 |
H40.1320 | H40.1321 | H40.1322 | H40.1323 | H40.1324 | H40.1330 | H40.1331 |
H40.1332 | H40.1333 | H40.1334 | H40.1390 | H40.1391 | H40.1392 | H40.1393 |
H40.1394 | H40.1410 | H40.1411 | H40.1412 | H40.1413 | H40.1414 | H40.1420 |
H40.1421 | H40.1422 | H40.1423 | H40.1424 | H40.1430 | H40.1431 | H40.1432 |
H40.1433 | H40.1434 | H40.1490 | H40.1491 | H40.1492 | H40.1493 | H40.1494 |
H40.151 | H40.152 | H40.153 | H40.159 | H40.20X0 | H40.20X1 | H40.20X2 |
H40.20X3 | H40.20X4 | H40.211 | H40.212 | H40.213 | H40.219 | H40.2210 |
H40.2211 | H40.2212 | H40.2213 | H40.2214 | H40.2220 | H40.2221 | H40.2222 |
H40.2223 | H40.2224 | H40.2230 | H40.2231 | H40.2232 | H40.2233 | H40.2234 |
H40.2290 | H40.2291 | H40.2292 | H40.2293 | H40.2294 | H40.231 | H40.232 |
H40.233 | H40.239 | H40.241 | H40.242 | H40.243 | H40.249 | H40.30X0 |
H40.30X1 | H40.30X2 | H40.30X3 | H40.30X4 | H40.31X0 | H40.31X1 | H40.31X2 |
H40.31X3 | H40.31X4 | H40.32X0 | H40.32X1 | H40.32X2 | H40.32X3 | H40.32X4 |
H40.33X0 | H40.33X1 | H40.33X2 | H40.33X3 | H40.33X4 | H40.40X0 | H40.40X1 |
H40.40X2 | H40.40X3 | H40.40X4 | H40.41X0 | H40.41X1 | H40.41X2 | H40.41X3 |
H40.41X4 | H40.42X0 | H40.42X1 | H40.42X2 | H40.42X3 | H40.42X4 | H40.43X0 |
H40.43X1 | H40.43X2 | H40.43X3 | H40.43X4 | H40.50X0 | H40.50X1 | H40.50X2 |
H40.50X3 | H40.50X4 | H40.51X0 | H40.51X1 | H40.51X2 | H40.51X3 | H40.51X4 |
H40.52X0 | H40.52X1 | H40.52X2 | H40.52X3 | H40.52X4 | H40.53X0 | H40.53X1 |
H40.53X2 | H40.53X3 | H40.53X4 | H40.60X0 | H40.60X1 | H40.60X2 | H40.60X3 |
H40.60X4 | H40.61X0 | H40.61X1 | H40.61X2 | H40.61X3 | H40.61X4 | H40.62X0 |
H40.62X1 | H40.62X2 | H40.62X3 | H40.62X4 | H40.63X0 | H40.63X1 | H40.63X2 |
H40.63X3 | H40.63X4 | H40.811 | H40.812 | H40.813 | H40.819 | H40.821 |
H40.822 | H40.823 | H40.829 | H40.831 | H40.832 | H40.833 | H40.839 |
H40.89 | H40.9 | H42 | Q15.0 |