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
1
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




Last Updated: 05/29/2020