Medicare Administrative Contractors (MACs) begin to roll out policies for new ERG codes

Although the new ERG code changes went into effect January 1, 2019, only recently have MACs begun to publish policies that reflect the deletion of code 92275 and the new codes established to replace it.  The 3 new ERG codes for 2019 are:

• 92273:   Electroretinography (ERG), with interpretation and report; full field (ie, ffERG, flash ERG, Ganzfeld ERG)
• 92274:   Electroretinography (ERG), with interpretation and report; multifocal (mfERG)
• 0509T:   Electroretinography (ERG) with interpretation and report, pattern (PERG)

Only three (3) MACs have published policies at this point; you can link to the respective policies below:

• First Coast Service Options (FCSO) – (link here)
• National Governmental Services (NGS) – (link here)
• Wisconsin Physicians Services (WPS) – (link here)

Each of these MACs have lists of diagnoses eligible for coverage; they vary only slightly for the two Category I codes 92273 and 92274.  Importantly, none of the three policies published to date allow any ERG code as a covered service when the disease is glaucoma of any type (including glaucoma suspect).

Interestingly, only NGS and FCSO appear to have 0509T, the new Category III code, as a covered service – albeit only for the non-glaucomatous diagnoses listed in their policies.  WPS does not list it as covered for any reason.  In other MAC jurisdictions and for private payers for whom prior authorization is not possible and no coverage decision is published, we recommend some form of ABN or financial waiver; in those cases it will be a patient-pay service so set your fee appropriately and collect at the time of service.

We are happy to assist providers and groups in any way with this or other coverage topics, as well as proper code selection, chart reviews, payer action questions – please contact us.  We can also provide training on these or other subjects.  You can reach us via the link to our main webpage or at the phone number below.  You can also download our “App”, Corcoran 24/7, which can be separately accessed via one of the links below.

www.corcoranccg.com (800) 399-6565