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CPT Code: 76514  Region:  02

States covered:  Connecticut, Illinois, Minnesota, Maine, Massachusetts, New York, New Hampshire, Rhode Island, Vermont

Title:  Corneal Pachymetry

Category
Ophthalmic Ultrasound

Description
Corneal pachymetry, unilateral or bilateral (determination of corneal thickness)

FEE SCHEDULE



PROCEDURE DESCRIPTION

Corneal Pachymetry is the measurement of corneal thickness and commonly uses either ultrasonic or optical methods. Measurement of corneal thickness in individuals presenting with increased intraocular pressure assists in determining if there is a risk of glaucoma or if the individual’s increased eye pressure is the result of abnormal corneal thickness. The test must be integral to the medical management decision-making of the patient.  Coverage is limited to ophthalmologists and optometrists.

CLINICAL INDICATIONS

Indications and Limitations

Medicare will consider corneal pachymetry to be medically necessary and reasonable when performed to determine the amount of endothelial trauma sustained during surgery, assessment of the health of the cornea pre-operatively in Fuch’s dystrophy, post ocular trauma and for the assessment of corneal thickness or (in suspected glaucoma) following the diagnosis of increased intraocular pressure prior to the initiation of a treatment regimen for glaucoma. It is expected that services for the measurement of corneal thickness following the diagnosis of increased intraocular pressure will be performed once in a lifetime, unless there has been interval corneal trauma or surgery.

Medicare will consider corneal pachymetry to be medically necessary and reasonable when performed only by ophthalmologist and optometrists.

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).

Whether patients have been previously diagnosed and are under treatment for glaucoma or are newly diagnosed, pachymetry will be covered once per lifetime, or more frequently in cases where there has been surgical or non-surgical trauma.

When there is a question of corneal disease supported by diagnosis, then pachymetry may be performed at the same time as endothelial cell count.

COVERED DIAGNOSES

ICD-10 Diagnosis Codes:




DOCUMENTATION REQUIREMENTS

Medical record documentation maintained by the ordering/referring physician must indicate the medical necessity for performing the test and the test results.  In addition, if the service exceeds the frequency parameter listed in this policy, documentation of medical necessity must be submitted.  This information is usually found in the history and physical, office/progress notes, or test results.

If the provider of the service is other than the ordering/referring physician, that provider must maintain hard copy documentation of test results and interpretation, along with copies of the ordering/referring physician’s order for the studies.  The physician must state the clinical indication/medical necessity for the study in his order for the test.

Documentation should contain a history and physical which supports the diagnosis for which this service is being rendered.

CODING GUIDELINES

Report a corneal pachymetry measurement with CPT code 76514. 

UTILIZATION GUIDELINES

It is expected that these services would be performed as indicated by current medical literature and/or standards of practice. When services are performed in excess of established parameters, they may be subject to review for medical necessity.

It is expected that services for the measurement of corneal thickness following the diagnosis of increased intraocular pressure will be performed once in a lifetime, unless there has been interval corneal trauma or surgery.

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