Summary & Overview
CPT 76511: Quantitative A–Scan Ophthalmic Ultrasound
CPT code 76511 denotes quantitative A–scan ultrasound imaging of intraocular and orbital structures, a diagnostic ophthalmic procedure that provides precise axial measurements and acoustic information used in evaluation and management of ocular conditions. Nationally, this code matters for clinical workflows in ophthalmology and for payers because it supports preoperative assessments, biometric measurements for intraocular lens calculations, and diagnosis of intraocular masses or posterior segment abnormalities.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what CPT code 76511 represents, common sites of service, and how this service fits into ophthalmic diagnostic pathways. The publication outlines benchmark considerations, coding and billing context, and relevant clinical applications tied to ocular measurement and orbital evaluation. Where payer-specific coverage details or utilization benchmarks are not provided in the input, the text indicates that data is not available in the input.
This summary orients clinical coders, billing professionals, and policy analysts to the primary purpose of CPT code 76511, its typical use settings, and the national payers relevant to reimbursement and policy discussions.
Billing Code Overview
CPT code 76511 describes quantitative A–scan ultrasound imaging of the eye, used to evaluate intraocular and orbital structures. This service obtains precise axial measurements and acoustic data to assess ocular dimensions and relationships among intraocular and orbital tissues.
Service type: Diagnostic ophthalmic ultrasound, quantitative A-scan
Typical site of service: Ophthalmology clinic, outpatient imaging suite, or hospital outpatient department
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient presents to an ophthalmology clinic with progressive visual loss and a history of cataract surgery in the affected eye. The ophthalmologist suspects posterior segment pathology and needs quantitative intraocular measurements of axial length and intraocular structure assessment prior to cataract extraction planning or to evaluate for intraocular mass or retinal detachment. The clinical workflow begins with nursing intake and history focusing on visual changes, prior ocular surgeries, and ocular pain. Visual acuity and intraocular pressure are measured. The provider performs a focused ocular exam; when media opacity or other conditions limit optical biometry or direct visualization, the provider orders quantitative A–scan ultrasound (CPT 76511). A licensed ophthalmologist or trained ultrasonographer performs the A–scan in a dedicated procedure room using appropriate topical anesthesia. Measurements are obtained from one or both eyes, recorded in the chart, and used to calculate intraocular lens power if indicated or to document axial length and presence of intraocular mass/retinal detachment. Results are interpreted by the provider who documents findings, measurement values, and clinical impression. The encounter may include the professional component billed by the physician and the technical component billed by the facility or diagnostic imaging service, as appropriate.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component |