2025 CPT code 92136
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Diagnostic - Ophthalmic Biometry Ophthalmology Feed
Ophthalmic biometry using partial coherence interferometry, including intraocular lens power calculation.
Modifiers -26 (professional component) can be appended when the physician performs only the professional component and the technical component is performed by another entity. Modifier -50 (bilateral procedure) is generally not needed for Medicare; payment inherently accounts for bilateral procedures, though may be required by other payers.Other modifiers may be applicable depending on the specific circumstances of the service.
Accurate IOL power calculation is medically necessary to maximize the chances of achieving the desired refractive outcome after cataract surgery or lens replacement. Inaccurate calculations can lead to refractive errors, requiring additional procedures such as refractive enhancement.
The ophthalmologist or other qualified healthcare professional is responsible for performing the biometry procedure using PCI, interpreting the results, and calculating the IOL power. They must ensure the accuracy and reliability of the measurements and calculations to guarantee the success of the subsequent surgery.
In simple words: This test uses a special device to measure your eye(s) precisely to determine the correct strength of an artificial lens that will be implanted during cataract surgery or other eye surgery.This ensures you get the best vision possible after the surgery.
This CPT code encompasses ophthalmic biometry performed via partial coherence interferometry (PCI) to determine the necessary intraocular lens (IOL) power for cataract surgery or other lens replacement procedures.The procedure involves non-invasive measurements of the eye's axial length, lens thickness, anterior chamber depth, and corneal curvature (keratometry). These measurements are then used with specialized software to calculate the optimal IOL power for achieving the desired refractive outcome post-surgery. The service may be performed on one or both eyes.
Example 1: A patient is scheduled for cataract surgery and requires pre-operative ophthalmic biometry using PCI to determine the correct IOL power. This ensures optimal visual acuity post-surgery., A patient has undergone prior refractive surgery, requiring PCI biometry to improve the accuracy of IOL power calculation for subsequent cataract surgery., A patient presents with high myopia or hyperopia, requiring highly precise PCI biometry measurements for accurate IOL power calculation, optimizing the chances of achieving emmetropia after cataract extraction.
* Detailed patient history including prior eye surgeries, medications, and relevant medical conditions.* Comprehensive ophthalmic examination including visual acuity, refraction, and slit-lamp biomicroscopy.* PCI biometry measurements including axial length, lens thickness, anterior chamber depth, and keratometry.* Software used for IOL power calculation with specific parameters and results documented.* Physician's interpretation of the results and justification for the selected IOL power.
** Always refer to the most current CPT manual and payer-specific guidelines for accurate coding and reimbursement. The payment for this code may vary widely depending on payer policies and geographic location.Medicare considers this a bilateral service, meaning the payment is adjusted to account for both eyes if the procedure is performed on both.
- Revenue Code: 0022 (Ophthalmology)
- RVU: The relative value units (RVUs) for this code will vary based on geographic location, facility type, and other factors.Consult the CMS Physician Fee Schedule for the most current RVU values. Medicare's payment policy considers this procedure bilateral, meaning that a modifier -50 is unnecessary; the payment rate already reflects a bilateral procedure. The professional component can be billed separately using modifier -26.
- Global Days: This code does not have a defined global period.The payment is for the biometry procedure only, not for any subsequent surgical procedures. Note that Medicare's payment structure already encompasses bilateral procedures.
- Payment Status: Active
- Modifier TC rule: The technical component (TC) of this code can be billed separately using modifier -TC.However, billing rules may vary depending on the payer and the specific circumstances.Medicare generally handles this billing for bilateral procedures intrinsically.
- Fee Schedule: Historical fee schedule information is not available in the provided sources. Consult the CMS Physician Fee Schedule for historical data.
- Specialties:Ophthalmology
- Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center