ICD-10-CM 2026 · Effective October 1, 2025

ICD-10 R94.111

Billable / Specific

Abnormal electroretinogram [ERG]

R94
Block
1
Synonyms
54
LCDs
6
Payer Policies
0
Linked CPTs

About ICD-10-CM R94.111

ICD-10-CM code R94.111 represents Abnormal electroretinogram [ERG]. This is a billable/specific code in the Symptoms, Signs, and Abnormal Findings chapter (block R94). The 2026 edition of ICD-10-CM R94.111 became effective on October 1, 2025.

Inclusion Terms / Approximate Synonyms

Clinical terms and conditions classified under R94.111. Per CMS ICD-10-CM Tabular 2026.

  • Abnormal retinal function study

Medicare LCD Coverage for R94.111

Local Coverage Determinations (LCDs) from CMS MACs that list R94.111 as a covered diagnosis.

54 LCDs

Showing top 10 of 54 total . Click a CPT for full coverage scope.

CMS LCD: Billing and Coding: Ophthalmology: Extended Ophthalmoscopy and Fundus Photography
Article ID: 53060, Effective: 2025-10-01 00:00:00, 1692 covered, 0 non-covered
CPT 92201 →
CMS LCD: Billing and Coding: Ophthalmology: Extended Ophthalmoscopy and Fundus Photography
Article ID: 53060, Effective: 2025-10-01 00:00:00, 1692 covered, 0 non-covered
CPT 92250 →
CMS LCD: Billing and Coding: Ophthalmology: Extended Ophthalmoscopy and Fundus Photography
Article ID: 53060, Effective: 2025-10-01 00:00:00, 1692 covered, 0 non-covered
CPT 92202 →
CMS LCD: Billing and Coding: Ophthalmology: Extended Ophthalmoscopy and Fundus Photography
Article ID: 53060, Effective: 2025-10-01 00:00:00, 1692 covered, 0 non-covered
CPT 92227 →
CMS LCD: Billing and Coding: Ophthalmology: Extended Ophthalmoscopy and Fundus Photography
Article ID: 53060, Effective: 2025-10-01 00:00:00, 1692 covered, 0 non-covered
CPT 92228 →
CMS LCD: Billing and Coding: Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)
Article ID: 56726, Effective: 2025-10-01 00:00:00, 1480 covered, 0 non-covered
CPT 92201 →
CMS LCD: Billing and Coding: Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)
Article ID: 56726, Effective: 2025-10-01 00:00:00, 1480 covered, 0 non-covered
CPT 92250 →
CMS LCD: Billing and Coding: Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)
Article ID: 56726, Effective: 2025-10-01 00:00:00, 1480 covered, 0 non-covered
CPT 92202 →
CMS LCD: Billing and Coding: Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)
Article ID: 56726, Effective: 2025-10-01 00:00:00, 1480 covered, 0 non-covered
CPT 92227 →
CMS LCD: Billing and Coding: Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)
Article ID: 56726, Effective: 2025-10-01 00:00:00, 1480 covered, 0 non-covered
CPT 92228 →

Commercial Payer Coverage

Coverage policies from major commercial payers referencing R94.111.

6 policies

5 Medicare

Billing and Coding: Ophthalmology: Extended Ophthalmoscopy and Fundus Photography
Policy ID: ART-53060
Billing and Coding: Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)
Policy ID: ART-56726
Billing and Coding: Neurophysiology Evoked Potentials (NEPs)
Policy ID: ART-56773
Billing and Coding: Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)
Policy ID: ART-57071
Billing and Coding: MRI and CT Scans of the Head and Neck
Policy ID: ART-57204

1 Aetna

Fundus Photography
Policy ID: CPB-0539

CPT Codes Commonly Billed with R94.111

Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.

No procedure linkages on file for R94.111

We don't have CPT pairings indexed for this specific code yet. Use the CPT search above to find common procedures, or check your payer's published medical policy for code-specific guidance.

Convert R94.111 to ICD-9-CM

Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.

ICD-10ICD-9Mapping Flags
R94.111 79411 00000

Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).

ICD-10 R94.111, Billing FAQ

Is ICD-10 code R94.111 billable? +

Yes, R94.111 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.

What other names or terms map to R94.111? +

ICD-10 R94.111 includes: Abnormal retinal function study.

What ICD-9 codes does R94.111 map to? +

Per CMS GEMs, R94.111 maps to ICD-9 codes: 79411. Useful for legacy data review and historical claim analysis.

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Reviewed by the PayerReady Medical Coding Team

Verified against the CMS 2026 code set on May 31, 2026.

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