Print | ShareCPT Code: 76513 Region: 37
States covered: General guidelines if your state does not have a local coverage determination
Title: Anterior Segment Ultrasound or High Resolution Biomicroscopy
Category
Ophthalmic Ultrasound
Description
Anterior segment ultrasound, immersion (water bath) B-scan or high resolution biomicroscopy
This Medicare carrier does not have a local coverage determination (LCD) for anterior segment imaging or high resolution biomicroscopy. The policy presented is a sample and is provided as a reference guide only and should not be construed as policy for your current Medicare carrier.
Ophthalmic ultrasounds involve the transmission of high-frequency sound waves through the eye and the measurement of their reflection from ocular structures. An A-scan converts the resulting echoes into waveforms whose crests represent the position of different structures. The B-scan converts the echoes into patterns of dots that form a two-dimensional, cross-sectional image of the ocular structure.
Ocular and orbital echography and sonography, jointly referred to as ultrasonography, are medically appropriate diagnostic tools to diagnose and/or follow ocular and orbital pathologies.
Identification and/or follow-up for the following:
- Disorders of the globe
- Retinal defects and detachments
- Other retinal disorders
- Disorders of the choroid
- Disorders of the iris and ciliary body
- Cataract
- Corneal scars and opacities
- Other corneal disorders
- Disorders of the orbit
- Disorders of the optic nerve
- Other disorders of the eye
- Disorders of the vitreous
- Disorders of the lens
- Congenital anomalies of corneal size and shape
- Neoplasm of the eye
- Injury to the eye
- Systemic disease
ICD-10 Diagnosis Codes
| ICD-10 Code | Description |
|---|---|
| A18.51 | Tuberculous episcleritis |
| A18.53 | Tuberculous chorioretinitis |
| A18.59 | Other tuberculosis of eye |
| C69.00 - C69.92 | Malignant neoplasm of unspecified conjunctiva - Malignant neoplasm of unspecified site of left eye |
| C79.32 - C79.49 | Secondary malignant neoplasm of cerebral meninges - Secondary malignant neoplasm of other parts of nervous system |
| D09.20 - D09.22 | Carcinoma in situ of unspecified eye - Carcinoma in situ of left eye |
| D18.09 | Hemangioma of other sites |
| D31.00 - D31.92 | Benign neoplasm of unspecified conjunctiva - Benign neoplasm of unspecified part of left eye |
| D48.7 | Neoplasm of uncertain behavior of other specified sites |
| D49.81 - D49.89 | Neoplasm of unspecified behavior of retina and choroid - Neoplasm of unspecified behavior of other specified sites |
| D57.00 - D57.219 | Hb-SS disease with crisis, unspecified - Sickle-cell/Hb-C disease with crisis, unspecified |
| D57.80 - D57.819 | Other sickle-cell disorders without crisis - Other sickle-cell disorders with crisis, unspecified |
| E08.311 - E08.3599 | Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy with macular edema - Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema, unspecified eye |
| E08.37X1 - E08.37X9 | Diabetes mellitus due to underlying condition with diabetic macular edema, resolved following treatment, right eye - Diabetes mellitus due to underlying condition with diabetic macular edema, resolved following treatment, unspecified eye |
| E09.311 - E09.3599 | Drug or chemical induced diabetes mellitus with unspecified diabetic retinopathy with macular edema - Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eye |
| E09.37X1 - E09.37X9 | Drug or chemical induced diabetes mellitus with diabetic macular edema, resolved following treatment, right eye - Drug or chemical induced diabetes mellitus with diabetic macular edema, resolved following treatment, unspecified eye |
| E10.311 - E10.3599 | Type 1 diabetes mellitus with unspecified diabetic retinopathy with macular edema - Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eye |
| E11.311 - E11.3599 | Type 2 diabetes mellitus with unspecified diabetic retinopathy with macular edema - Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eye |
| E11.37X1 - E11.37X9 | Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, right eye - Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, unspecified eye |
| E13.311 - E13.3599 | Other specified diabetes mellitus with unspecified diabetic retinopathy with macular edema - Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eye |
| E13.37X1 - E13.37X9 | Other specified diabetes mellitus with diabetic macular edema, resolved following treatment, right eye - Other specified diabetes mellitus with diabetic macular edema, resolved following treatment, unspecified eye |
| E85.1 - E85.9 | Neuropathic heredofamilial amyloidosis - Amyloidosis, unspecified |
| G45.3 | Amaurosis fugax |
| H05.00 - H05.049 | Unspecified acute inflammation of orbit - Tenonitis of unspecified orbit |
| H05.10 - H05.129 | Unspecified chronic inflammatory disorders of orbit - Orbital myositis, unspecified orbit |
| H05.20 - H05.269 | Unspecified exophthalmos - Pulsating exophthalmos, unspecified eye |
| H05.50 - H05.53 | Retained (old) foreign body following penetrating wound of unspecified orbit - Retained (old) foreign body following penetrating wound of bilateral orbits |
| H05.811 - H05.819 | Cyst of right orbit - Cyst of unspecified orbit |
| H05.821 - H05.89 | Myopathy of extraocular muscles, right orbit - Other disorders of orbit |
| H15.001 - H15.9 | Unspecified scleritis, right eye - Unspecified disorder of sclera |
| H16.241 - H16.249 | Ophthalmia nodosa, right eye - Ophthalmia nodosa, unspecified eye |
| H17.00 - H17.9 | Adherent leukoma, unspecified eye - Unspecified corneal scar and opacity |
| H18.001 - H18.009 | Unspecified corneal deposit, right eye - Unspecified corneal deposit, unspecified eye |
| H18.011 - H18.069 | Anterior corneal pigmentations, right eye - Stromal corneal pigmentations, unspecified eye |
| H18.10 - H18.13 | Bullous keratopathy, unspecified eye - Bullous keratopathy, bilateral |
| H18.20 - H18.239 | Unspecified corneal edema - Secondary corneal edema, unspecified eye |
| H18.50 - H18.59 | Unspecified hereditary corneal dystrophies - Other hereditary corneal dystrophies |
| H18.70 - H18.799 | Unspecified corneal deformity - Other corneal deformities, unspecified eye |
| H21.00 - H21.359 | Hyphema, unspecified eye - Exudative cyst of pars plana, unspecified eye |
| H21.40 - H21.43 | Pupillary membranes, unspecified eye - Pupillary membranes, bilateral |
| H25.20 - H25.23 | Age-related cataract, morgagnian type, unspecified eye - Age-related cataract, morgagnian type, bilateral |
| H25.89 | Other age-related cataract |
| H26.101 - H26.139 | Unspecified traumatic cataract, right eye - Total traumatic cataract, unspecified eye |
| H26.40 - H26.499 | Unspecified secondary cataract - Other secondary cataract, unspecified eye |
| H27.10 - H27.139 | Unspecified dislocation of lens - Posterior dislocation of lens, unspecified eye |
| H30.001 - H32 | Unspecified focal chorioretinal inflammation, right eye - Chorioretinal disorders in diseases classified elsewhere |
| H33.001 - H33.8 | Unspecified retinal detachment with retinal break, right eye - Other retinal detachments |
| H34.00 - H34.9 | Transient retinal artery occlusion, unspecified eye - Unspecified retinal vascular occlusion |
| H35.00 - H35.09 | Unspecified background retinopathy - Other intraretinal microvascular abnormalities |
| H35.171 - H35.469 | Retrolental fibroplasia, right eye - Secondary vitreoretinal degeneration, unspecified eye |
| H35.50 - H35.739 | Unspecified hereditary retinal dystrophy - Hemorrhagic detachment of retinal pigment epithelium, unspecified eye |
| H35.81 - H35.89 | Retinal edema - Other specified retinal disorders |
| H36 | Retinal disorders in diseases classified elsewhere |
| H43.00 - H43.9 | Vitreous prolapse, unspecified eye - Unspecified disorder of vitreous body |
| H44.001 - H44.19 | Unspecified purulent endophthalmitis, right eye - Other endophthalmitis |
| H44.50 - H44.9 | Unspecified degenerated conditions of globe - Unspecified disorder of globe |
| H46.10 - H46.13 | Retrobulbar neuritis, unspecified eye - Retrobulbar neuritis, bilateral |
| H47.021 - H47.029 | Hemorrhage in optic nerve sheath, right eye - Hemorrhage in optic nerve sheath, unspecified eye |
| H47.10 - H47.149 | Unspecified papilledema - Foster-Kennedy syndrome, unspecified eye |
| H47.20 - H47.299 | Unspecified optic atrophy - Other optic atrophy, unspecified eye |
| H47.311 - H47.399 | Coloboma of optic disc, right eye - Other disorders of optic disc, unspecified eye |
| H57.03 | Miosis |
| H57.8 | Other specified disorders of eye and adnexa |
| Q10.7 | Congenital malformation of orbit |
| Q13.0 - Q13.9 | Coloboma of iris - Congenital malformation of anterior segment of eye, unspecified |
| Q14.0 - Q14.9 | Congenital malformation of vitreous humor - Congenital malformation of posterior segment of eye, unspecified |
| Q15.0 | Congenital glaucoma |
| S05.10XA - S05.32XS | Contusion of eyeball and orbital tissues, unspecified eye, initial encounter - Ocular laceration without prolapse or loss of intraocular tissue, left eye, sequela |
| S05.50XA - S05.92XS | Penetrating wound with foreign body of unspecified eyeball, initial encounter - Unspecified injury of left eye and orbit, sequela |
| T15.00XA - T15.02XS | Foreign body in cornea, unspecified eye, initial encounter - Foreign body in cornea, left eye, sequela |
| T85.22XA - T85.22XS | Displacement of intraocular lens, initial encounter - Displacement of intraocular lens, sequela |
| T85.318A - T85.318S | Breakdown (mechanical) of other ocular prosthetic devices, implants and grafts, initial encounter - Breakdown (mechanical) of other ocular prosthetic devices, implants and grafts, sequela |
| T85.328A - T85.328S | Displacement of other ocular prosthetic devices, implants and grafts, initial encounter - Displacement of other ocular prosthetic devices, implants and grafts, sequela |
| T85.398A - T85.398S | Other mechanical complication of other ocular prosthetic devices, implants and grafts, initial encounter - Other mechanical complication of other ocular prosthetic devices, implants and grafts, sequela |
| T86.840 - T86.849 | Corneal transplant rejection - Unspecified complication of corneal transplant |
1. The medical record should clearly indicate the condition being evaluated and the primary diagnosis should support the medical necessity of the testing and must be maintained by the ordering/referring physician.
2. The medical record should be legible and include patient identification such as complete name, date of service and include the name of the physician responsible for and providing the care of the patient.
3. Documentation should be available to Medicare upon request.
Report a High Resolution Biomicroscopy procedure with CPT code 76513.
An ophthalmic ultrasound procedure may be reported as a unilateral global service.
This Medicare carrier does not have specific utilization guidelines for ophthalmic ultrasound. One (1) ophthalmic ultrasound (either A-scan or B-scan) may be allowed per eye per year. If these services are required more than once a year, a copy of the medical record that supports the medical necessity may be requested for review.