Does 92274 require prior authorization?

No, 92274 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 92274?

Medicare facility rate: $92.19. Non-facility rate: $92.19. Work RVU: 0.59.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.59

Facility

$92.19

Non-Facility

$92.19

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.
An IDTF must be credentialed and approved by Palmetto GBA provider enrollment to bill Medicare for a specific diagnostic procedure or material.
Additional services and supplies (e.g., radiopharmaceuticals, special contrast agents, medications) are payable to an IDTF when the diagnostic test itself is payable and the supplies are commonly separately reimbursed to a physician in an office setting.
A supervising physician for an IDTF must be licensed in the state(s) where tests are performed, enrolled in Medicare, not excluded, meet proficiency standards for tests supervised, and provide general supervision for no more than three IDTF sites.
An interpreting physician must be licensed in the state(s) where tests are performed, enrolled in Medicare, not excluded, and qualified to interpret the types of tests (codes) listed on the IDTF enrollment application.
An IDTF technician must meet applicable state licensure and/or certification standards at the time of enrollment and/or at the time tests are performed and be qualified to perform the types of tests (codes) listed in the enrollment application.

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

L37398 — Electroretinography (ERG)

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