Medicare Reimbursement for Corneal Pachymetry

Corneal pachymetry is a measurement of the thickness of the cornea. The normal human cornea is approximately 550 microns thick centrally and a full millimeter thick peripherally. A pachy-meter is most often used to measure the central cornea, although there are diseases that warrant a “patchette” or pachymetry grid across a wide area..

Pachymetry is customarily ordered when a diseased cornea is edematous or ectatic.  It is also used prior to LASIK to help plan the photoablation and in glaucoma evaluations.

This FAQ addresses the following:

1. What is corneal pachymetry?
2. What are the indications for corneal pachymetry?
3. What CPT code describes this test?
4. What documentation is required to support a claim for corneal pachymetry?
5. Does Medicare cover corneal pachymetry?
6. Is the physician’s presence required while pachymetry is being performed?
7. How much does Medicare allow for corneal pachymetry?
8. If coverage of pachymetry is unlikely or uncertain, how should we proceed?
9. How frequently is this test performed?

A Pachymetry Interpretation Report is also included.

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