Ophthalmic Biometry and A-Scans Coding Guidelines
According to the Medicare Fee Schedule Database (MPFSDB), the global and technical components of CPT codes 76519 and 92136 are BILAT (bilateral) indicator "2" codes and the professional components are BILAT indicator "3" codes. As a result, unique coding requirements apply.
CPT code 76516 and its technical and professional components are BILAT indicator "2" codes, so usual coding requirements apply.
The following chart outlines how to code the various components of these codes when they are performed bilaterally or unilaterally.
Please do not use CPT modifier 50 or HCPCS modifier RT or LT with these codes. CPT modifier 26 and HCPCS modifier TC must be submitted in the first modifier field (when applicable).
|
Procedure
Performed
|
Components Performed
|
CPT
Code
|
HCPCS
CPT
Modifier
|
Days/Units
(Quantity)
|
|
Ophthalmic Biometry A-Scan
CPT code 76516
|
Bilateral technical component and Bilateral professional component
|
76516
|
|
1
|
|
Bilateral technical component
|
76516
|
TC
|
1
|
|
|
Bilateral professional component
|
76516
|
26
|
1
|
|
|
Unilateral technical component
|
76516
|
TC 52
|
1
|
|
|
Unilateral professional component
|
76516
|
26 52
|
1
|
|
|
Unilateral technical component and
Unilateral professional component
|
76516
|
52
|
1
|
|
|
Ophthalmic Biometry A-Scan with IOL Power Calculation
CPT code 76519
|
Bilateral technical component and Unilateral professional component
|
76519
|
|
1
|
|
Bilateral technical component
|
76519
|
TC
|
1
|
|
|
Bilateral professional component
|
76519
|
26
|
2
|
|
|
Unilateral technical component
|
76519
|
TC 52
|
1
|
|
|
Unilateral professional component
|
76519
|
26
|
1
|
|
|
Unilateral technical component and
Unilateral professional component
|
76519
|
52
|
1
|
|
|
Ophthalmic Biometry
CPT code 92136
|
Bilateral technical component and Unilateral professional component
|
92136
|
|
1
|
|
Bilateral technical component
|
92136
|
TC
|
1
|
|
|
Bilateral professional component
|
92136
|
26
|
2
|
|
|
Unilateral technical component
|
92136
|
TC 52
|
1
|
|
|
Unilateral professional component
|
92136
|
26
|
1
|
|
|
Unilateral technical component and
Unilateral professional component
|
92136
|
52
|
1
|
CPT Modifier 52
- When CPT modifier 52 is submitted on a bilateral code (CPT codes and CPT/HCPCS modifier 76516, 76516-TC, 76516–26, 76519, 76519-TC, 92136, 92136-TC) to indicate it was performed unilaterally rather than bilaterally, it is expected that the submitted amount will also be reduced with respect to the lower level of service
- Although CPT modifier 52 normally requires that documentation be submitted explaining why the service is reduced, no documentation is required when submitting CPT modifier 52 with these codes
- The allowed amount will be adjusted to reflect a unilateral service was performed
Coding Examples
CPT codes 92136, 92136-TC and 92136-26 are used in the following examples; however, the same coding requirements apply to CPT code 76519 and its components. Refer to the chart above for coding of CPT code 76516 and its components.
Bilateral Technical and Bilateral Professional Ophthalmic Biometry Same Day
|
Date Performed
|
CPT Code
|
CPT Modifier
|
Quantity
|
|
1/3/2017
|
92136
|
|
1
|
|
1/3/2017
|
92136
|
26
|
1
|
Bilateral Technical and Unilateral Professional Ophthalmic Biometry Same Day and Then the Other Unilateral Professional Performed a Subsequent Day
|
Date Performed
|
CPT Code
|
CPT Modifier
|
Quantity
|
|
1/3/2017
|
92136
|
|
1
|
|
1/4/2017
|
92136
|
26
|
1
|
Bilateral Technical Ophthalmic Biometry Same Day
|
Date Performed
|
CPT Code
|
HCPCS Modifier
|
Quantity
|
|
1/3/2017
|
92136
|
TC
|
1
|
Unilateral Technical Ophthalmic Biometry
|
Date Performed
|
CPT Code
|
HCPCS/CPT Modifier
|
Quantity
|
|
1/3/2017
|
92136
|
TC 52
|
1
|
Unilateral Technical and Unilateral Professional Ophthalmic Biometry Same Day
|
Date Performed
|
CPT Code
|
CPT Modifier
|
Quantity
|
|
1/3/2017
|
92136
|
52
|
1
|
Unilateral Professional Ophthalmic Biometry
|
Date Performed
|
CPT Code
|
CPT Modifier
|
Quantity
|
|
1/3/2017
|
92136
|
26
|
1
|
Bilateral Professional Ophthalmic Biometry Same Day
|
Date Performed
|
CPT Code
|
CPT Modifier
|
Quantity
|
|
1/3/2017
|
92136
|
26
|
2
|
Coverage is limited to Ophthalmic Biometry and A-Scans when they are considered by Medicare to be reasonable and necessary. It is not considered reasonable and necessary to evaluate each eye more than once in preparation for cataract surgery.
MPFSDB Bilateral Indicator (BILAT)
- BILAT 2 means the RVUs assigned to the code being performed bilaterally
- BILAT 3 means the RVUs assigned to code being performed unilaterally