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 |