Does 92273 require prior authorization?

No, 92273 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 92273?

Medicare facility rate: $123.25. Non-facility rate: $123.25. Work RVU: 0.67.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.67

Facility

$123.25

Non-Facility

$123.25

All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
Every page of the medical record must be legible and include appropriate patient identification information, such as full name and dates of service.
The record must include the legible signature of the physician or non-physician practitioner responsible for and providing the patient's care.
The submitted medical record must support the use of the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.

Coverage for electroretinography (ERG) is determined by Local Coverage Determination (LCD) L37371; ERG is covered only when reasonable and necessary per LCD L37371.
Electroretinography (ERG) is covered when medically necessary and consistent with locally accepted standards of practice and is supported by an appropriate ICD-10-CM diagnosis that best describes the patient's condition.
For diagnostic ERG tests, report the test result if known; if the result is not known at time of billing, report the symptoms that prompted the performance of the test.
Perform peripheral venous ultrasound to evaluate clinical signs or symptoms suggestive of acute or new-onset deep vein thrombosis (e.g., extremity swelling, tenderness, erythema).
Perform venous ultrasound to investigate DVT as the source of a confirmed pulmonary embolism.
Repeat or perform venous ultrasound for patients with known venous thrombosis who have a clinical change and where documented change in thrombus burden would alter management or therapy.

A57599 — Billing and Coding: Visual Electrophysiology Testing

J05

L37015 — Visual Electrophysiology Testing

J05

A57060 — Billing and Coding: Visual Electrophysiology Testing

J06

L36831 — Visual Electrophysiology Testing

J06

A57677 — Billing and Coding: Electroretinography (ERG)

Ask Verity about documentation requirements, denial risks, or coverage in your state.