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AetnaAll Plans · Coverage · Medical Policy · Ophthalmology, Neurology, Psychiatry +2 moreMedium impact

Electroretinography (CPB 0854, reviewed 2025-12-24)

Effective date
Not stated in the notice
Identified
Aug 14, 2026

Summary

The electroretinography (ERG) policy was last reviewed December 24, 2025. ERG is medically necessary for the work-up of congenital nystagmus and as an adjunctive modality for establishing loss of retinal function and distinguishing retinal from optic nerve lesions, full-field ERG is medically necessary for congenital stationary night blindness and for evaluating Vogt-Koyanagi-Harada disease and exudative retinal detachment, and multi-focal ERG is medically necessary for detecting chloroquine and hydroxychloroquine toxicity. ffERG or mfERG is medically necessary for evaluating Stargardt disease in children, while full-field flash ERG monitoring during endoscopic trans-sphenoidal pituitary mass resection, global flash ERG for refractive errors, and pattern ERG for antidepressant selection, amblyopia, depression, glaucoma, macular drusen and all other indications are experimental, investigational or unproven.

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What to do

Action · 4 steps
01Billing team: Bill full-field ERG (CPT 92273) only for the covered indications in this policy: work-up of congenital nystagmus (ICD-10 H55.01), congenital stationary night blindness (ICD-10 H53.63), Vogt-Koyanagi-Harada disease, exudative retinal detachment, and Stargardt disease in children.
02Bill multi-focal ERG (CPT 92274) only for detecting chloroquine or hydroxychloroquine toxicity, using ICD-10 Z79.899 for long-term drug therapy, and use ICD-10 H35.53 for Stargardt disease only with mfERG.
03Do not bill pattern ERG (CPT 0509T) for the indications the policy lists as not covered, including amblyopia, depression, glaucoma and macular drusen.
04Do not bill full-field flash ERG monitoring during endoscopic trans-sphenoidal pituitary mass resection, global flash ERG for refractive errors, or ERG for screening for chloroquine and hydroxychloroquine retinopathy, because the policy lists these as experimental.

Codes mentioned

922739227462165D18.09H53.63H55.01H35.53Z79.899Z85.841

Original notice

Electroretinography (CPB 0854, reviewed 2025-12-24)
aetna.com · Always check the source before changing claims.
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Related policy hubs

Aetna policiesOphthalmologyNeurologyPsychiatryPediatricsSleep MedicineCode 92273Code 92274Code 62165Code D18.09Code H53.63Code H55.01Code H35.53Code Z79.899Code Z85.841

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