2025 CPT code 76514
(Active) Effective Date: N/A Revision Date: N/A Diagnostic - Diagnostic Ultrasound Procedures of the Head and Neck Radiology Feed
Ultrasound scan of the cornea to determine thickness.
Modifiers 26 (professional component) and TC (technical component) are applicable. Modifier 50 (bilateral) may be used if both eyes are assessed. Refer to payer guidelines for allowed modifier use.
Corneal pachymetry is medically necessary for accurate assessment of corneal thickness, crucial for diagnosing and managing various ophthalmological conditions like glaucoma and for pre-operative planning before procedures such as LASIK.The thickness of the cornea impacts intraocular pressure measurements and can affect treatment decisions.Medical necessity must be supported by clinical documentation.
The ophthalmologist or other qualified healthcare professional performs the ultrasound procedure, measures the corneal thickness, and interprets the results to assess eye pressure, diagnose conditions such as glaucoma, and manage treatment.
In simple words: The doctor uses sound waves to measure the thickness of the cornea (the clear front part of the eye). This helps assess eye pressure and diagnose or manage eye conditions. The measurement is recorded and interpreted by the doctor.
This CPT code encompasses the use of ultrasound technology to measure corneal thickness.The procedure involves using a contact B-scan imaging technique to obtain multiple readings, discarding the highest and lowest values, and averaging the remaining measurements to determine the corneal thickness in microns.The result is documented in the patient's medical record along with interpretation of its impact on intraocular pressure.
Example 1: A patient presents with suspected glaucoma. Corneal pachymetry (76514) is performed to accurately measure corneal thickness before intraocular pressure measurement, which helps determine the appropriate glaucoma diagnosis and treatment., A patient is being evaluated for LASIK surgery.Pre-operative corneal pachymetry (76514) provides essential data for surgical planning and risk assessment, helping to determine the suitability of the patient for this procedure., A patient has experienced a corneal injury. Corneal pachymetry (76514) is used to monitor the healing process and assess the extent of corneal damage.
** Medicare has a once-in-a-lifetime benefit for pachymetry for patients with glaucoma (payer specific).Always verify payer-specific guidelines and policies before billing.
- Revenue Code: M5C (Specialist - Ophthalmology)
- RVU: Refer to CMS conversion factors and payer-specific reimbursement rates. RVUs vary by geographic location and facility type.
- Global Days: Not applicable; this is a diagnostic procedure.
- Payment Status: Active
- Modifier TC rule: Modifier TC may apply if the technical component (image acquisition) is reported separately from the professional component (interpretation). Hospital billing may have different rules.
- Fee Schedule: Refer to publicly available fee schedules for historical data.Reimbursement rates vary by payer, location, and year.
- Specialties:Ophthalmology
- Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center