Summary & Overview
CPT 76519: A-Scan Ultrasound Ocular Biometry for IOL Calculation
CPT code 76519 represents A-scan ultrasound echography used to measure axial eye length and calculate intraocular lens (IOL) power before cataract surgery. This diagnostic biometry procedure is essential to achieving accurate refractive outcomes after lens implantation and is widely performed in ophthalmology practices and ambulatory surgery settings. Nationally, precise ocular measurements supported by this code affect surgical planning, patient outcomes, and perioperative workflow.
Key payers covered in this publication include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for the procedure, payer coverage considerations, and typical sites of service. The piece summarizes common modifiers associated with billing for the service and highlights where input data was unavailable.
This report provides benchmarks and policy-relevant points useful for practice managers, billing professionals, and clinicians involved in preoperative cataract care. Topics addressed include clinical purpose of the measurement, where the service is typically delivered, and the scope of payer coverage discussed. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 76519 describes the use of A-scan ultrasound echography to measure the axial length of the eye and perform intraocular lens (IOL) calculation prior to cataract surgery. This service is a diagnostic ocular biometry procedure used to determine the appropriate IOL power for patients undergoing cataract extraction.
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Service type: Diagnostic ocular biometry (A-scan ultrasound) for IOL calculation
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Typical site of service: Ophthalmology clinic or ambulatory surgical center where preoperative eye measurements are performed
Clinical & Coding Specifications
Clinical Context
A 72-year-old patient with progressive visual decline from a dense cataract is scheduled for preoperative evaluation prior to elective cataract extraction with intraocular lens (IOL) implantation. In clinic, the ophthalmologist documents visual acuity, a dilated slit-lamp exam confirming lens opacity, and discusses surgical risks and refractive goals. To determine the appropriate IOL power, the provider performs 76519 (A-scan ultrasound axial length measurement) when optical biometry (e.g., partial coherence interferometry) is unavailable or unreliable due to dense cataract, corneal opacity, or poor fixation. The measurement workflow includes topical anesthesia as needed, placement of the ultrasound probe on the applanation surface or immersion technique, three consistent axial length readings for each eye, corneal curvature data from keratometry or topography, and calculation of IOL power using the selected formula. Results are documented in the operative plan and used to order the appropriate IOL power for the scheduled cataract extraction procedure performed in an ambulatory surgery center or hospital outpatient department.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the physician’s interpretation/measurement component separate from technical services. |