Corneal Pachymetry

Medicare considers corneal pachymetry medically necessary when it is integral to medical management for specific indications: assessing endothelial trauma from corneal surgery, preoperative evaluation in Fuchs' dystrophy, post-ocular trauma assessment, and assessment of corneal thickness in suspected glaucoma prior to initiating treatment; coverage is limited to ophthalmologists and optometrists (with authorized non-physician outpatient exceptions). A once-per-lifetime coverage limit applies for pachymetry performed in conjunction with a glaucoma diagnosis unless there has been intervening corneal trauma or surgery; no lifetime limit applies for assessments after trauma or for Fuchs' dystrophy. Pachymetry is not covered for preparation for refractive surgery (except when corneal shape change results from prior corneal transplant), and providers must follow limitation-of-liability rules including written beneficiary notice when the service may not be covered.