Where this LCD applies
Each contract number is a jurisdiction on the remittance; the policy binds claims processed under these contracts and no others.
| Contract | Contractor | Type | States |
|---|---|---|---|
| 15102 | CGS Administrators, LLC | MAC - Part B | KY |
| 15202 | CGS Administrators, LLC | MAC - Part B | OH |
| 15101 | CGS Administrators, LLC | MAC - Part A | KY |
| 15201 | CGS Administrators, LLC | MAC - Part A | OH |
Billing and coding: diagnoses and procedure codes
Since 2019 the codes live in the companion article rather than the LCD. Billing and Coding A58706 (Billing and Coding: Electroretinography (ERG)) carries the diagnosis and procedure lists the contractor loads as the claims edit. CPT codes are shown as bare numbers because the descriptors are licensed by the AMA; HCPCS Level II descriptors are public and shown.
A58706: Billing and Coding: Electroretinography (ERG) (Billing and Coding, effective 2023-11-16)
- Covered ICD-10-CM codes
- 570
- 1 group
- Non-covered ICD-10-CM codes
- 0
- Procedure codes listed
- 3
- Full article
- cms.gov record
| ICD-10-CM | Description (FY2027) |
|---|---|
| A18.53 | — |
| B50.0 | — |
| B50.8 | — |
| B50.9 | — |
| 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 | — |
Procedure codes: 0509T, 92273, 92274.
Coverage indications, limitations and medical necessity
Electroretinography (ERG) is considered reasonable and medically necessary for:
• Detection of loss of retinal function, OR
• To distinguish retinal from optic nerve lesions, OR
• Detecting chloroquine and hydroxychloroquine toxicity
ERG is investigational for all other indications, including glaucoma.
Background:
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. ERGs are usually obtained using electrodes embedded in a corneal contact lens or a thin wire inside the lower eyelid, which measures a summation of retinal electrical activity at the corneal surface. The ERG provides information about the macula, composed mainly of cones and used for primary central and color vision, and the rest of the retina is mainly composed of rod photoreceptors, used in peripheral and night (scotopic) vision. By providing information about the rods and cones, ERG helps distinguish retinal degeneration and dystrophies. 1 The International Society for Clinical Electrophysiology of Vision (ISCEV) introduced minimum ERG standards in 1989. The ERG helps to distinguish retinal degeneration and dystrophies. 2 The widespread use of electrophysiological measurements has been hindered by limitations associated with its widespread clinical implication and large magnitude of measurement variability. 3
Definitions:
Full-Field ERG (ffERG)- measures mass response for the retina in response to flashing lights and is valuable for conditions with widespread retinal dysfunction but not useful for small retinal lesions. 4
Focal ERG (fERG)- also called foveal ERG, measures the functional integrity of the central macula. 4
Multifocal ERG (mfERG)- higher resolution form of ERG, enabling assessment of ERG activity in small areas of the retina by measuring local ERG responses and providing spatial information. It measures the photoreceptors and aids in the detection of localized abnormalities within the macula. 2,4
Pattern electroretinography (PERG) (also called reversal pattern ERG) uses pattern-reversal stimuli to elicit electrical activity in the retina and monitor retinal ganglion cell activity, and used to detect subtle optic neuropathies. 2,5
Photopic Negative Response ERG (PhNR) is a slow ERG wave recorded under photopic conditions and accesses ganglion cells on cones and bipolar cells. 6
Summary of evidence (opening)
ERG for Retinal Dysfunction
ERG has played a role as a diagnostic tool for retinal disease since its inception in the 1940s. It has become a standard tool for the assessment of retinal function. It plays a role in the early detection of diabetic retinopathy, and there are treatments if detected early. ERG, in various forms, provides an objective assessment of retinal function and can aid in assessment and monitoring in treatment outcomes for acquired and hereditary retinal disorders. There is robust literature composed of hundreds of articles to support ERG and mfERG for retinal evaluation. 7 Full-field ERG is limited as the recording is massed potential from the whole retina. Unless 20% or more of the retina is affected, the ffERG may be normal. Multi-focal ERG produces higher resolution images than ffERG, allowing assessment of a smaller area of the retina. 8 The International Society for Clinical Electrophysiology of Vision (ISCEV) established a guideline for ERG testing. 9-12 Literature for PERG is limited.
The American Academy of Ophthalmology (AOA) Clinical Assessment of Patients with Inherited Retinal Degenerations 13 includes ERG. The guidelines state: "The full-field electroretinogram (ERG) is important for diagnosis and staging of disease and is useful for many patients with diffuse photoreceptor disease to evaluate the retina-wide function of rods and cones. Multifocal ERG testing can be useful for detection and monitoring disease progression for diseases that primarily affect the macula. However, its accuracy can be limited in those patients with a notable loss of central vision who are unable to maintain steady foveal fixation." They also recommend following ISCEV standards so recordings can be compared between institutions and examiners.
The supporting literature includes support for the use of ERG for the following indications: 4,7
The contractor cites 54 sources in the bibliography; the full summary and analysis of evidence are in the CMS record.
Dates, lineage and related policies
- Original determination effective
- 2022-01-30
- Current revision effective
- 2023-01-12
- MCD version
- 14
Other related documents: A58943 (Response to Comments).
Using this policy on a claim
Match the documented indication to the covered indications above before the service is scheduled, carry a diagnosis from the article's covered list on the claim line, and keep the elements the documentation section asks for in the record, because the contractor can request it later through medical review. A denial under this policy arrives as CARC 50 with remark N115; the LCD lookup guide walks through the appeal path and the Advance Beneficiary Notice rules, and the CGS Administrators, LLC hub lists every other active policy from the same contractor.
The same policy title at other contractors
Contractors often adopt each other's policies and then revise them separately, so the criteria and the diagnosis lists drift apart. The topic comparison lines up every version.
Frequently asked questions
What does LCD L38992 cover?
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. ERGs are usually obtained using electrodes embedded in a corneal contact lens or a thin wire inside the lower eyelid, which measures a summation of… The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database export of September 24, 2026.
Which states does LCD L38992 apply to?
CGS Administrators, LLC applies it to Medicare claims in KY, OH. A Local Coverage Determination binds only the contractor that wrote it; the same service in another jurisdiction is judged under that contractor's own policy or, where none exists, claim by claim.
Which diagnosis codes support medical necessity under LCD L38992?
The companion billing and coding article A58706 lists 570 ICD-10-CM codes in 1 group that support medical necessity; the first 24 appear on this page and the complete list is in the article on cms.gov.
How do I appeal a denial under LCD L38992?
The remittance carries claim adjustment reason code 50 with remark code N115, naming the LCD. Compare the documented indication with the policy's covered indications and the article's diagnosis list, then file a redetermination within 120 days with the record attached; if the service genuinely falls outside the policy, the patient can be billed only when a valid Advance Beneficiary Notice was obtained before the service.
Sources
Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-02. Verify against the primary file before billing or contracting decisions.
- Medicare Coverage Database, current LCD exportVersion MCD release 2026-09-24 · effective 2026-09-20 · file lcd.csvSHA-256 2fcc4251b6ddd1eb…
- Medicare Coverage Database, current Billing and Coding Articles exportVersion MCD release 2026-09-24 · effective 2026-09-20 · file article.csvSHA-256 f31932f1df3b4035…
- ICD-10-CM FY2027 code descriptionsVersion FY2027 · effective 2026-10-01 · file icd10cm_codes_2027.txtSHA-256 3c0583a38ee0e848…
Disclaimer
The policy text and code lists are reproduced from the CMS Medicare Coverage Database export as an operational reference. Verify against the current LCD and article on cms.gov before billing; coverage depends on the full record and the contractor. Not legal, clinical or billing advice.