Billing and Coding: Corneal Pachymetry

This billing and coding guidance for corneal pachymetry outlines administrative requirements: verify NCCI/OPPS edits, include referring/ordering physician name and NPI when required, and supply a valid ICD-10-CM diagnosis code. Documentation must include provider assessment, relevant history, test results (or symptoms if results unavailable), and signed/dated records; use ABN Form CMS‑R‑131 and appropriate -GA/-GX/-GZ/-GY modifiers per CMS guidance with specific Part A MAC requirements (occurrence code 32 and ABN date).

"Procedure codes for corneal pachymetry may be subject to National Correct Coding Initiative (NCCI) edits or OPPS packaging edits and should be checked against NCCI/OPPS prior to billing."

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