Summary & Overview
CPT 76514: Corneal Pachymetry via Ophthalmic Ultrasound
CPT code 76514 represents the diagnostic procedure of corneal pachymetry, an ophthalmic ultrasound used to measure corneal thickness in one or both eyes. This test is essential in the management of corneal diseases, preoperative assessment for refractive surgery, and monitoring conditions such as glaucoma. The code is widely recognized and reimbursed by major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare, reflecting its clinical importance and broad coverage.
This publication provides a comprehensive overview of 76514, including payer coverage, clinical indications, and typical sites of service. Readers will gain insight into current policy updates, utilization benchmarks, and the clinical context for corneal pachymetry. The analysis also highlights relevant modifiers, associated taxonomies, and ICD-10 diagnoses commonly linked to this procedure. By understanding the scope and application of 76514, stakeholders can better navigate the evolving landscape of ophthalmic diagnostic services and ensure accurate billing and compliance.
CPT Code Overview
CPT code 76514 is used for ophthalmic ultrasound, echography, diagnostic; corneal pachymetry, which involves the unilateral or bilateral determination of corneal thickness. This procedure is a key diagnostic tool in ophthalmology, particularly for assessing corneal health and guiding treatment decisions for various corneal disorders. The service is typically performed in an office setting (POS 11) or an outpatient facility, allowing for efficient evaluation and management of patients with corneal conditions.
Clinical & Coding Specifications
Clinical Context
A patient presents to an ophthalmology clinic with symptoms suggestive of corneal disease, such as blurred vision, corneal edema, or a history of corneal transplant. The ophthalmologist determines that corneal pachymetry is necessary to assess corneal thickness, which is critical for diagnosing and managing conditions like corneal edema, bullous keratopathy, corneal degenerations, or evaluating post-transplant status. The procedure is performed using ophthalmic ultrasound echography, either unilaterally or bilaterally, in an office or outpatient facility setting. The results inform further management, such as monitoring disease progression or planning surgical interventions.
Coding Specifications
| Modifier Code | Description | When to Use |
|---|---|---|
52 | Reduced services | Used if corneal pachymetry is performed on only one eye |
RT | Right side | Used when the procedure is performed unilaterally on the right eye |
LT | Left side | Used when the procedure is performed unilaterally on the left eye |
Associated Provider Taxonomies:
207W00000X- Ophthalmology (specialists in eye diseases and procedures)208000000X- Diagnostic Radiology (specialists in diagnostic imaging, including ultrasound)
Related Diagnoses
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H47.231- Disorder of optic chiasm, right eye- Relevant when corneal thickness assessment is needed due to optic chiasm disorders affecting vision.
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H47.232- Disorder of optic chiasm, left eye- Used when left eye involvement necessitates corneal evaluation.
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H47.233- Disorder of optic chiasm, bilateral- Indicates bilateral optic chiasm disorders requiring corneal assessment.
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H18.511- Other corneal edema, right eye- Corneal pachymetry is essential for quantifying edema severity.
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H18.512- Other corneal edema, left eye- Used for left eye corneal edema evaluation.
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H18.513- Other corneal edema, bilateral- Bilateral corneal edema assessment with pachymetry.
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H18.501- Unspecified corneal edema, right eye- Used when corneal edema is present but not further specified.
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H18.502- Unspecified corneal edema, left eye- For left eye cases of unspecified corneal edema.
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H18.503- Unspecified corneal edema, bilateral- Bilateral unspecified corneal edema assessment.
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H18.521- Bullous keratopathy, right eye- Pachymetry helps monitor corneal thickness changes in bullous keratopathy.
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H18.522- Bullous keratopathy, left eye- For left eye bullous keratopathy evaluation.
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H18.523- Bullous keratopathy, bilateral- Bilateral bullous keratopathy assessment.
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H18.531- Corneal degenerations, right eye- Used to assess corneal thickness in degenerative conditions.
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H18.532- Corneal degenerations, left eye- For left eye corneal degeneration evaluation.
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H18.533- Corneal degenerations, bilateral- Bilateral corneal degeneration assessment.
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H18.541- Peripheral corneal thinning, right eye- Pachymetry is critical for measuring peripheral thinning.
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H18.542- Peripheral corneal thinning, left eye- For left eye peripheral thinning assessment.
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H18.543- Peripheral corneal thinning, bilateral- Bilateral peripheral thinning evaluation.
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H18.551- Corneal punctate epithelial erosion, right eye- Used when corneal thickness may be affected by epithelial erosion.
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H18.552- Corneal punctate epithelial erosion, left eye- For left eye epithelial erosion assessment.
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H18.553- Corneal punctate epithelial erosion, bilateral- Bilateral epithelial erosion evaluation.
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H18.591- Other specified disorders of cornea, right eye- Used for corneal disorders requiring thickness measurement.
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H18.592- Other specified disorders of cornea, left eye- For left eye specified corneal disorders.
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H18.593- Other specified disorders of cornea, bilateral- Bilateral specified corneal disorders assessment.
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T86.8481- Corneal transplant status, right eye- Pachymetry is important for monitoring post-transplant corneal thickness.
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T86.8482- Corneal transplant status, left eye- For left eye post-transplant evaluation.
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T86.8483- Corneal transplant status, bilateral- Bilateral corneal transplant status assessment.
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T86.8491- Other postprocedural state, cornea, right eye- Used for postprocedural corneal thickness monitoring.
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T86.8492- Other postprocedural state, cornea, left eye- For left eye postprocedural assessment.
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T86.8493- Other postprocedural state, cornea, bilateral- Bilateral postprocedural corneal assessment.
Related CPT Codes
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92286- Internal eye photography- Used to document internal structures of the eye, often performed alongside corneal pachymetry to provide comprehensive diagnostic information.
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92134- Computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report- Used for imaging the posterior segment of the eye, such as the retina and optic nerve. This may be performed in conjunction with corneal pachymetry when evaluating overall ocular health or specific conditions affecting both anterior and posterior segments.
Both 92286 and 92134 are commonly used together with 76514 in diagnostic workflows for complex corneal and ocular conditions, or as alternatives depending on the clinical indication.
National Reimbursement Benchmarks
For CPT code 76514, national mean rates for commercial payers (BUCA average) are notably higher than Medicare, with BUCA at $12.59 and Medicare at $8.02. This reflects a substantial gap between government and commercial reimbursement levels.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies across payers. Medicare shows the widest spread ($7.00), indicating greater variability in rates, while Blue Cross Blue Shield has the tightest range ($5.83), suggesting more consistent reimbursement. Other commercial payers fall between these extremes.
The table and chart below present a detailed breakdown of national benchmarks for each payer, including mean rates and percentile values.
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