Billing and Coding: Corneal Pachymetry

Corneal pachymetry (optical or ultrasonic) is covered primarily to evaluate corneal thickness in patients with increased intraocular pressure, generally once in a lifetime unless interval corneal trauma or corneal surgery has occurred, in which case repeat testing is allowable. Billing must use CPT 92499 for optical pachymetry (include the phrase 'Optical Pachymetry' on claims) or CPT 76514 for ultrasonic pachymetry (reimbursed bilaterally as one unit); documentation of medical necessity, ordering physician name/NPI, valid ICD-10 diagnosis code, H&P, and test results are required, and services beyond stated frequency may be reviewed for medical necessity.

"Corneal pachymetry (measurement of corneal thickness) is covered to evaluate patients with a diagnosis of increased intraocular pressure."

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