Summary & Overview
CPT 92274: Multifocal Electroretinography (mfERG) for Retinal Function
CPT code 92274 denotes multifocal electroretinography (mfERG), an electrophysiologic diagnostic test that measures localized retinal function to detect focal retinal abnormalities and cone–rod dysfunction. Nationally, mfERG is a clinically important tool for diagnosing retinal disorders that may not be evident on structural imaging alone, informing specialty ophthalmology and retinal care pathways.
Key payers in this review include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The analysis summarizes coverage and billing contexts across major commercial payers and federal programs, highlighting clinical indications and service settings.
Readers will find a concise clinical context for the procedure, typical sites of service, and an overview of billing considerations tied to CPT code 92274. The publication outlines benchmarks commonly monitored in payer contracts, summarizes policy and coverage themes relevant to electrophysiology testing of the retina, and provides clarity on what documentation and clinical rationale are typically associated with this diagnostic service. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 92274 describes an electrophysiologic test of retinal function consisting of multifocal electroretinography (mfERG) to detect localized retinal abnormalities or cone–rod dysfunction. The procedure evaluates electrical responses generated by the retina, helping to identify focal retinal dysfunction and disturbances in rod and cone activity that affect visual function and color vision.
Service type: Diagnostic electrophysiology of the retina (multifocal electroretinography, mfERG)
Typical site of service: Ophthalmology clinic, retinal specialty center, or hospital outpatient diagnostic facility
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult referred by an ophthalmologist or retina specialist for evaluation of localized retinal dysfunction, persistent visual symptoms, or suspected cone–rod dystrophy. Example scenario: a 52-year-old patient reports progressive central vision blur and metamorphopsia in one eye over several months. Visual acuity and dilated fundus exam show subtle macular changes without clear etiology. The clinician orders multifocal electroretinography to map localized retinal (primarily macular and cone system) electrical responses to detect focal dysfunction and to differentiate maculopathy from optic nerve or cortical causes. Clinical workflow: the patient arrives to an outpatient ophthalmic electrodiagnostic laboratory or hospital outpatient department; pupils are pharmacologically dilated; corneal or foil electrodes are placed after topical anesthesia; the technician records multifocal ERG signals while the patient fixates on a patterned stimulus; the provider interprets waveforms, compares to normative data, documents localized amplitude and implicit time abnormalities, and integrates findings with clinical exam, OCT, fluorescein angiography, and visual field testing as indicated. Typical site of service: ophthalmology clinic-based electrodiagnostic lab or hospital outpatient department specializing in retinal diagnostics.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing only the physician interpretation of the mfERG separate from technical recording |