Medicare Reimbursement for A-Scan Biometry (Accutome)

FREQUENTLY ASKED QUESTIONS: 

MEDICARE REIMBURSEMENT FOR A-SCAN BIOMETRY

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Q  What is A-scan ultrasonography?

A  A-scan is an abbreviation for amplitude modulation scan using high frequency sound waves (ultrasound).  It provides information in one dimension, such as length.  In ophthalmology, A-scan ultrasound biometry is used to measure the axial length of the eye, which is important in cataract surgery and for some other conditions such as orbital tumors.1.  Accutome’s A-scan Plus Connect is an effective solution for measuring and calculating intraocular lens power prior to cataract surgery.

 

Q  What CPT code describes A-scan biometry with IOL calculation?

A  CPT code 76519 (Ophthalmic biometry by ultrasound echography, A scan; with intraocular lens power calculation) describes this test.

 

Q  What chart documentation is required to support this service?

A  CPT notes, “For those codes whose sole diagnostic goal is a biometric measure (i.e., 76514, 76516, 76519), permanently record images are not required. A final written report should be issued for inclusion in the patient’s medical record. The prescription form for the intraocular lens satisfies the written report requirement for 76519.”  

As a practical matter, an IOL power is usually selected for each eye.  The A-scan record should show a date, IOL power and physician signature for each eye.

 

Q  What diagnoses support claims for this test?

A  A-scan biometry is most frequently used for the diagnosis and management of cataract.  Covered diagnoses for A-scan fall in the ranges of H25.- & H26.- (366.xx)* and Q12.- (743.30 to 743.3).

*  ICD-10 and ICD-9 codes, respectively.  A dash (-) at the end of an ICD-10 code indicates that there are more digits to follow.

 

Q  Does Medicare cover A-scan biometry?

A  Yes.  Medicare’s National Coverage Determination §10.1 provides for, “…a single scan to determine the appropriate pseudophakic power of the IOL…”.  The policy further states, “In most cases involving simple cataract, a diagnostic ultrasound A-scan is used.” 

 

Q  How much does Medicare allow for this test?

A  The 2015 national Medicare Physician Fee Schedule allowable for 76519 is $86.  Of this amount, $54 is assigned to the technical component and $32 is the value of the professional component (interpretation).  These amounts are adjusted in each area by local wage indices.  Other payers set their own rates, which may differ significantly from the Medicare published fee schedule.

76519 is subject to Medicare’s Multiple Procedure Payment Reduction (MPPR).  This reduces the allowable for the technical component of the lesser-valued test when more than one test is performed on the same day.

 

Q  Is 76519 unilateral or bilateral?

A  CPT does not specify, but the Medicare Physician Fee Schedule defines the technical component as bilateral and the professional component as unilateral.  For example:

A 72 y/o male is examined and cataract surgery is planned OS. A-scan is ordered and both eyes are measured. The proper power is selected for the left eye only at this time. The IOL power for the right eye will be selected later. The claim will read as follows:

76519-LT

    (or)

76519-TC and 76519-26LT

A claim for the subsequent selection of IOL power for the right eye will read as follows:

      76519-26RT

Note that some Medicare contractors have issued instructions to submit these claims without RT and LT modifiers.  Check your MAC’s policy. Other payers may have different policies.

 

Q  Is the physician’s presence required while the A-scan is being performed?

A  Under Medicare program standards, this test requires general supervision.  General supervision means the procedure is furnished under the physician’s overall direction and control, but the physician’s presence is not required during the performance of the procedure.

 

Q  Will Medicare cover repeat testing?

A  Sometimes.  Repeated biometry is indicated when there is reason to distrust an earlier measurement.  For example, a scleral buckling procedure may lengthen the eye, a prior IOL calculation produced an undesirable outcome, or the earlier A-scan measurement was made a long time ago (>12 months). 

 

Q  Is concurrent A-scan and optical coherence biometry (92136) reimbursed?

A  No.  One of the tests is duplicative.  NCCI edits preclude claims for both tests. 

 

1.  For more information on orbital tumors, request Accutome’s monograph on ultrasound from Corcoran.

 

Provided Courtesy of Accutome Inc.  (800) 979-2020

 

Last updated July 1, 2015

 

The reader is strongly encouraged to review federal and state laws, regulations, code sets (including ICD-9 and ICD-10), and official instructions promulgated by Medicare and other payers.  This document is not an official source nor is it a complete guide on reimbursement.  The reader is reminded that this information, including references and hyperlinks, changes over time, and may be incorrect at any time following publication.

 

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