Billing and Coding: Ophthalmic Biometry for Intraocular Lens Power Calculation

Medicare covers ophthalmic biometry (CPT 76519 or 92136) for preoperative IOL power calculation for cataract surgery, typically one A-scan for simple cataract or a B-scan when dense cataract prevents adequate A-scan measurements. Coverage is limited to one scan and one comprehensive exam for cataract-only cases unless an additional diagnosis and documented medical necessity justify further testing; either biometry method should not be billed more than once per 12 months by the same provider/group unless vision significantly changes. Claims must include a valid ICD-10 diagnosis, required modifiers and referring physician NPI where applicable, and complete medical record documentation (including the IOL power calculation) available to Medicare on request.

"Ophthalmic biometry (CPT 76519 or 92136) is covered for preoperative intraocular lens (IOL) power calculation for patients undergoing cataract surgery."