2025 CPT code 76519
(Active) Effective Date: N/A Revision Date: N/A Radiology - Diagnostic Ultrasound Procedures Radiology Feed
Ophthalmic biometry using A-scan ultrasound echography, including intraocular lens power calculation.
Modifiers 26 (professional component), TC (technical component), LT (left eye), and RT (right eye) may be used depending on the situation.
The medical necessity for code 76519 is established when an IOL power calculation is required before cataract surgery or other procedures involving IOL implantation. The accuracy of IOL power is critical for optimal visual outcomes after surgery.
The ophthalmologist or other qualified healthcare professional performs the A-scan ultrasound, interprets the results, and calculates the IOL power.This may involve a technician assisting with the technical aspects of the ultrasound.
In simple words: This test uses ultrasound to measure the length of your eye.This measurement helps determine the right type of artificial lens needed if you have cataract surgery or need a new lens for other eye conditions. The test uses sound waves to measure your eye, not a direct image.
This CPT code encompasses ophthalmic biometry performed using A-scan ultrasound echography to determine the axial length of the eye.The procedure involves calculating the power needed for an intraocular lens (IOL) implant, typically before cataract surgery.A-scan ultrasound uses high-frequency sound waves to generate a one-dimensional image of the eye's internal structures. The axial length is measured from the cornea to the retina, enabling precise IOL power calculation. The resulting data is crucial for determining the appropriate IOL to restore clear vision after cataract surgery or other conditions requiring lens replacement.
Example 1: A patient is scheduled for cataract surgery.An A-scan ultrasound (76519) is performed to measure the axial length of both eyes and calculate the IOL power for each eye. Only one 76519 is billed with modifier TC. A separate professional component for each eye can be billed using modifier 26 and the appropriate laterality modifier (LT or RT)., A patient presents with a diagnosis of aphakia (absence of the eye's lens). An A-scan is needed to determine the axial length for IOL implantation.Code 76519 is used, with considerations for modifiers as needed, depending on the specific situation and payer rules., A patient with high myopia requires IOL power calculation before cataract surgery.The ophthalmologist orders an A-scan ultrasound (76519) to ensure accurate IOL selection.Modifier -26 might be applied if the physician is billing only for the interpretation of the scan.
* Patient demographics and medical record number.* Physician's order specifying the need for IOL power calculation.* Detailed report of the A-scan ultrasound including axial length measurements for each eye.* Calculation of the IOL power for each eye, including the lens type recommended.* Documentation of any complications encountered during the procedure.
** Accurate documentation and appropriate use of modifiers are crucial for correct reimbursement.Consult your payer's specific billing instructions and NCCI edits to avoid claim denials.
- Revenue Code: I3A (ECHOGRAPHY - EYE)
- RVU: This information is not available in the provided text and varies based on payer and location.Consult the relevant fee schedule for the specific Relative Value Units (RVUs) and reimbursement rates.
- Global Days: This is typically considered a global service with the professional and technical components bundled, though the precise billing rules may depend on the payer and the setting (e.g., hospital versus private practice).
- Payment Status: Active
- Modifier TC rule: Modifier TC (Technical Component) can be used to specify the technical aspect of the A-scan ultrasound. The rules of payer may affect whether modifier TC is needed.
- Fee Schedule: Fee schedules vary by payer and location and are not consistently available in a readily accessible, centralized repository. Consult relevant fee schedules for historic data.
- Specialties:Ophthalmology
- Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center