How do I bill Medicare for pachymetry?

The optical pachymetry service should be billed and is valued equivalently to the ultrasonic service (CPT code 76514). Modifier RT, LT, or 50 (bilateral) should be reported with CPT code 92499, as appropriate. CPT code 76514 is reimbursed as a bilateral service (both eyes are included in a single test).

How do I bill Medicare for pachymetry?

The optical pachymetry service should be billed and is valued equivalently to the ultrasonic service (CPT code 76514). Modifier RT, LT, or 50 (bilateral) should be reported with CPT code 92499, as appropriate. CPT code 76514 is reimbursed as a bilateral service (both eyes are included in a single test).

How often can you bill for pachymetry?

once per lifetime
Corneal pachymetry can only be paid once per lifetime per provider. If you are seeing a glaucoma suspect patient for the first time, bill for pachymetry this one time only.

Is pachymetry covered by Medicare?

Indications and Limitations: Medicare will not pay for use of pachymetry when used in preparation for surgery to reshape the cornea of the eye for the purpose of correcting visual problems (refractive surgery), such as myopia (nearsightedness) and hyperopia (farsightedness).

Can 92132 and 92134 be billed together?

No, they cannot be billed at the same patient encounter, per CPT instructions. Most likely, an NCCI bundle for the two codes will be issued. Q. Please confirm that the 92133 would apply to an OCT of the optic nerve (99% sure that it is).

Is corneal topography covered by Medicare?

Corneal topography will be non-covered if performed pre- or post-operatively in relation to a non-covered procedure, i.e., radial keratotomy. As published in the CMS IOM Publication 100-08, Medicare Program Integrity Manual, Chapter 13, Section 13.5.

Do I need modifier for 76514?

Since CPT 76514 is inherently bilateral it should not be reported with any site modifiers (RT or LT). Also it would be inappropriate to use modifier -50 with it. This service includes the interpretation and report, therefore no professional and technical modifiers (-26 or -TC) should be used.

How often can you bill gonioscopy?

every 1 to 5 years
The AAO’s Preferred Practice Patterns suggests that gonioscopy be repeated periodically and mentions every 1 to 5 years. Repeat testing is indicated when medically necessary for new symptoms, progressive disease, new findings, unreliable prior results, or a change in the treatment plan.

Does CPT code 76514 need a modifier?

This code can only be used to report if the procedure is being performed using an Ultrasound technique. Since CPT 76514 is inherently bilateral it should not be reported with any site modifiers (RT or LT).

How often can you bill for gonioscopy?

How do you measure the thickness of the cornea?

Ultrasound pachymetry remains the gold standard for measuring corneal thickness; however, several non-contact methods are being used for this purpose by many clinicians. Orbscan II provides topographic information of the cornea as well as a corneal pachymetric map by using the scanning slit method.

Can 92250 and 92133 be billed together?

Coding Implications Fundus photography with interpretation and report—92250—and either 92133 or 92134 cannot be performed on the same date of service on the same patient.

What is the difference between CPT 92133 and 92134?

92134 retina As you can see, code 92134 in the CPT book is indented under 92133 and simply states “retina,” but it is read as follows: Scanning computer diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; retina.

What is the CPT code for corneal pachymetry?

While OCT may do a great job in measuring corneal thickness, the scan cannot be coded as corneal pachymetry, CPT 76514, which is defined as “ophthalmic ultrasound, diagnostic; corneal pachymetry, unilateral or bilateral (determination of corneal thickness).”

What is the CPT code for an Oct procedure?

Instead, you must use CPT code 92132, for which there is generally no diagnosis that would support the procedure; you may also find that 92132 is often considered non-covered as experimental and investigational by many insurance carriers. If you use your OCT for fitting a contact lens, you are also obligated to use CPT code 92132.

When is pachymetry indicated in the evaluation of corneal transplant patients?

A: Once primarily used in cases of corneal disease, pachymetry is also part of the preop evaluation of patients contemplating corneal transplant and those with bullous keratopathy and Fuchs’ dystrophy.

Can pachymetry be billed as a diagnostic test?

A: Currently, there are no bundles by the National Correct Coding Initiative that include pachymetry. Unless your carrier’s local medical review policy imposes restrictions, it can be performed and billed on the same day as an office visit and/or other diagnostic test.