Summary & Overview
CPT 76516: A-scan Ultrasound Measurement of Ocular Axial Length
CPT code 76516 represents A-scan ultrasound echography used to measure the axial length of the eye. This diagnostic ophthalmic procedure is clinically important for accurate intraocular lens power calculation before cataract surgery and for assessing globe dimensions in various ocular conditions. Nationally, the code is relevant to ophthalmology practices, ambulatory surgical centers, and payers that cover preoperative and diagnostic ocular imaging.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, common sites of service, and the payer landscape relevant to this procedure. The publication covers billing and coding considerations, frequent modifiers associated with ophthalmic ultrasound services, and bench-marking information where available. It also outlines the clinical scenarios that typically justify the service and highlights documentation elements often required by payers.
This summary provides clinicians, billing staff, and policy analysts with a national-level briefing on the role of 76516 in eye care management, payer coverage considerations, and the operational settings where the procedure is performed. Data not available in the input is noted where applicable in detailed sections.
Billing Code Overview
CPT code 76516 describes the use of A-scan ultrasound echography to measure the eyeball’s axial length. This service is a diagnostic ophthalmic ultrasound procedure that provides linear measurements of the eye, commonly used in preoperative planning for cataract surgery and in other clinical assessments of globe size.
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Service type: Diagnostic ophthalmic ultrasound (A-scan)
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Typical site of service: Ophthalmology clinic or ambulatory surgical center where ocular biometry is performed
Clinical & Coding Specifications
Clinical Context
A 68-year-old patient presents to an ophthalmology clinic for preoperative biometry prior to cataract extraction with intraocular lens (IOL) implantation. The ophthalmic technician or sonographer performs an A-scan ultrasound echography to measure axial length and anterior chamber depth. Measurements are obtained with the patient sitting at the slit-lamp or supine, using topical anesthesia and an immersion or contact probe as indicated. The provider (ophthalmologist or trained technician under physician supervision) reviews the A-scan results, selects the appropriate IOL power calculation formula, documents the axial length and any additional biometric parameters in the medical record, and incorporates the values into surgical planning. Typical sites of service include an ambulatory ophthalmology clinic, outpatient surgery center, or hospital outpatient department. The service is billed when objective ocular axial length measurement is necessary for IOL power calculation, evaluation of axial myopia or hyperopia, or when optical biometry is not possible due to dense cataract or poor fixation.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing only the physician interpretation or professional portion of the ultrasound reading |
TC |