CPT Code: 76516  Region: 37

States covered:  General guidelines if your state does not have a local coverage determination

Title:  Ophthalmic Biometry by A-scan

Category
Ophthalmic Ultrasound

Description
Ophthalmic biometry by ultrasound echography, A-scan

This Medicare carrier does not have a local coverage determination (LCD) for an ophthalmic biometry by A-scan.  The policy presented is a sample and it is provided as a reference guide only and should not be construed as policy for your current Medicare carrier.



There are two methods used for intraocular lens power calculation:

1. A-Scan Ultrasound Ophthalmic Biometry:

Ophthalmic A-scan biometry by ultrasound echography is performed through the optical axis of the eye to determine the power of an intraocular (IOL) lens implant.  The technical portion of ophthalmic biometry is usually performed in both eyes at the same setting.

2. Non-Ultrasound Ophthalmic Biometry:

Optical coherence biometry (OCB) utilizes partial coherence interferometry for measuring axial length (biometry) and for intraocular lens power calculation when planning for cataract surgery.  OCB also measures the corneal curvature and anterior chamber depth.  The technical portion is usually performed in both eyes at the same visit.

Ophthalmic Biometry with intraocular lens power calculation is indicated for patients who will undergo cataract extraction with lens implantation.

  • Identification and/or follow-up for cataract
  • Identification and/or follow-up for aphakia and other disorders of the lens
  • Post-operative management of ocular surgery

ICD-10 Diagnosis Codes

ICD-10 CodesDescription
E10.36 Type 1 diabetes mellitus with diabetic cataract
E11.36 Type 2 diabetes mellitus with diabetic cataract
E13.36 Other specified diabetes mellitus with diabetic cataract
H25.011 Cortical age-related cataract, right eye
H25.012 Cortical age-related cataract, left eye
H25.013 Cortical age-related cataract, bilateral
H25.031 Anterior subcapsular polar age-related cataract, right eye
H25.032 Anterior subcapsular polar age-related cataract, left eye
H25.033 Anterior subcapsular polar age-related cataract, bilateral
H25.041 Posterior subcapsular polar age-related cataract, right eye
H25.042 Posterior subcapsular polar age-related cataract, left eye
H25.043 Posterior subcapsular polar age-related cataract, bilateral
H25.11 Age-related nuclear cataract, right eye
H25.12 Age-related nuclear cataract, left eye
H25.13 Age-related nuclear cataract, bilateral
H25.21 Age-related cataract, morgagnian type, right eye
H25.22 Age-related cataract, morgagnian type, left eye
H25.23 Age-related cataract, morgagnian type, bilateral
H25.811 Combined forms of age-related cataract, right eye
H25.812 Combined forms of age-related cataract, left eye
H25.813 Combined forms of age-related cataract, bilateral
H25.89 Other age-related cataract
H25.9 Unspecified age-related cataract
H26.001 Unspecified infantile and juvenile cataract, right eye
H26.002 Unspecified infantile and juvenile cataract, left eye
H26.003 Unspecified infantile and juvenile cataract, bilateral
H26.011 Infantile and juvenile cortical, lamellar, or zonular cataract, right eye
H26.012 Infantile and juvenile cortical, lamellar, or zonular cataract, left eye
H26.013 Infantile and juvenile cortical, lamellar, or zonular cataract, bilateral
H26.031 Infantile and juvenile nuclear cataract, right eye
H26.032 Infantile and juvenile nuclear cataract, left eye
H26.033 Infantile and juvenile nuclear cataract, bilateral
H26.041 Anterior subcapsular polar infantile and juvenile cataract, right eye
H26.042 Anterior subcapsular polar infantile and juvenile cataract, left eye
H26.043 Anterior subcapsular polar infantile and juvenile cataract, bilateral
H26.051 Posterior subcapsular polar infantile and juvenile cataract, right eye
H26.052 Posterior subcapsular polar infantile and juvenile cataract, left eye
H26.053 Posterior subcapsular polar infantile and juvenile cataract, bilateral
H26.061 Combined forms of infantile and juvenile cataract, right eye
H26.062 Combined forms of infantile and juvenile cataract, left eye
H26.063 Combined forms of infantile and juvenile cataract, bilateral
H26.09 Other infantile and juvenile cataract
H26.101 Unspecified traumatic cataract, right eye
H26.102 Unspecified traumatic cataract, left eye
H26.103 Unspecified traumatic cataract, bilateral
H26.111 Localized traumatic opacities, right eye
H26.112 Localized traumatic opacities, left eye
H26.113 Localized traumatic opacities, bilateral
H26.121 Partially resolved traumatic cataract, right eye
H26.122 Partially resolved traumatic cataract, left eye
H26.123 Partially resolved traumatic cataract, bilateral
H26.131 Total traumatic cataract, right eye
H26.132 Total traumatic cataract, left eye
H26.133 Total traumatic cataract, bilateral
H26.20 Unspecified complicated cataract
H26.211 Cataract with neovascularization, right eye
H26.212 Cataract with neovascularization, left eye
H26.213 Cataract with neovascularization, bilateral
H26.221 Cataract secondary to ocular disorders (degenerative) (inflammatory), right eye
H26.222 Cataract secondary to ocular disorders (degenerative) (inflammatory), left eye
H26.223 Cataract secondary to ocular disorders (degenerative) (inflammatory), bilateral
H26.231 Glaucomatous flecks (subcapsular), right eye
H26.232 Glaucomatous flecks (subcapsular), left eye
H26.233 Glaucomatous flecks (subcapsular), bilateral
H26.31 Drug-induced cataract, right eye
H26.32 Drug-induced cataract, left eye
H26.33 Drug-induced cataract, bilateral
H26.8 Other specified cataract
H26.9 Unspecified cataract
H27.01 Aphakia, right eye
H27.02 Aphakia, left eye
H27.03 Aphakia, bilateral
H27.111 Subluxation of lens, right eye
H27.112 Subluxation of lens, left eye
H27.113 Subluxation of lens, bilateral
H27.121 Anterior dislocation of lens, right eye
H27.122 Anterior dislocation of lens, left eye
H27.123 Anterior dislocation of lens, bilateral
H27.131 Posterior dislocation of lens, right eye
H27.132 Posterior dislocation of lens, left eye
H27.133 Posterior dislocation of lens, bilateral
H28 Cataract in diseases classified elsewhere
Q12.0 Congenital cataract
Q12.1 Congenital displaced lens
Q12.2 Coloboma of lens
Q12.3 Congenital aphakia
Q12.4 Spherophakia
Q12.8 Other congenital lens malformations



ICD-9 Diagnosis Codes

ICD-9 Codes Description
366.00 - 366.04 Nonsenile cataract unspecified - nuclear nonsenile cataract
366.09 Other and combined forms of nonsenile cataract
366.10 Senile cataract unspecified
366.13 - 366.19 Anterior subcapsular polar senile cataract - other and combined forms of senile cataract
366.20 - 366.23 Traumatic cataract unspecified - partially resolved traumatic cataract
366.30 - 366.34 Cataracta complicata unspecified - cataract in degenerative ocular disorders
366.41 - 366.46 Diabetic cataract - cataract associated with radiation and other physical influences
366.8 Other cataract
366.9 Unspecified cataract
379.31 - 379.34 Aphakia - posterior dislocation of lens
743.30 - 743.35 Congenital cataract unspecified - congenital aphakia
743.36 Congenital anomalies of lens shape
743.37 Congenital ectopic lens
743.39 Other congenital cataract and lens anomalies
996.53 Mechanical complication of prosthetic ocular lens prosthesis


1. The medical record should clearly indicate the condition being evaluated and the primary diagnosis should support the medical necessity of the testing.

2. If an ophthalmic biometry procedure is performed in preparation for cataract surgery, the medical record documentation maintained by the performing provider must clearly indicate the medical necessity of the service being billed.  In addition, documentation that the service was performed must be included in the patient’s record in the office/progress notes and/or an operative report.  This documentation should include the patient’s name and date of service, the indications for testing, an order for testing, the results of testing, and the IOL power calculation.

3. Documentation must be available to Medicare upon request.

There are three ophthalmic biometry methods, but two of the three methods are used for intraocular lens power calculation.

  • A-Scan Ultrasound Ophthalmic Biometry
  • Optical Coherence Ophthalmic Biometry

Report an A-Scan Ultrasound Ophthalmic Biometry with CPT code 76516.

CPT code 76516 is classified as a bilateral procedure where the bilateral adjustment does not apply.  Because of this, this procedure should not be coded as a global service.

When testing both eyes, use the following coding guidelines:

To follow these coding guidelines, the technical component represents the performance of the procedure on both eyes.  It is reported on one service line with a -TC modifier.

The professional component is a unilateral procedure representing the interpretation of the test results on one eye. The right eye is reported on a second service line with a -26 modifier and its location modifier -RT.  The left eye is reported on a third service line with a -26 modifier and its location modifier -LT.

This Medicare carrier does not have specific utilization guidelines for ophthalmic biometry with IOL calculation.  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.