Description

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.

Criteria

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):

• Toxic retinopathies, including those caused by intraocular metallic foreign bodies, Vigabatrin and Chlorpromazine; or
• Diabetic retinopathy; or
• Retinal vascular disease (e.g., Central Retinal Artery Occlusion [CRAO], Transient Retinal Artery Occlusion, Central Retinal Vein Occlusion [CRVO], Branch Vein Occlusion [BVO], and sickle cell retinopathy); or
• Autoimmune retinopathies (e.g., Cancer Associated Retinopathy [CAR], Melanoma Associated Retinopathy [MAR], and Acute Zonal Occult Outer Retinopathy [AZOOR]); or
• Retinal detachment; or
• Assessment of retinal function after trauma (e.g., vitreous hemorrhage, dense cataracts, macula scars and other conditions where the fundus cannot be visualized); or
• Retinitis pigmentosa and related hereditary degenerations; or
• Retinitis punctata albescens; or
• Leber’s congenital amaurosis; or
• Choroideremia; or
• Gyrate atrophy of the retina and choroid; or
• Goldman-Favre syndrome; or
• Congenital stationary night blindness; or
• X-linked juvenile retinoschisis; or
• Achromatopsia; or
• Cone dystrophy; or
• Disorders mimicking retinitis pigmentosa; or
• Usher Syndrome; or
• Retinal Dystrophies (e.g., Stargardt’s disease, Fundus Flavimaculata, North Carolina macular dystrophy, Best’s Vitelliform dystrophy, Sorsby’s macular dystrophy).

All other indications for electroretinography not listed above, except glaucoma are considered not medically necessary.

Procedure Codes

mfERG may be considered medically necessary to detect chloroquine (Aralen) and hydroxychloroquine (Plaquenil) toxicity.

Procedure Codes

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.

Procedure Codes

Covered Diagnosis Codes for Procedure Codes 0509T, 92273 and 92274

Non-Covered Diagnosis Codes for Procedure Codes 0509T, 92273 and 92274

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