Medicare Reimbursement for Endothelial Cell Count

Medicare covers endothelial cell count performed with a specular microscope when medically necessary.  Medicare has a national coverage determination policy (NCD 80.8) addressing reimbursement for endothelial cell count (ECC), also known as endothelial cell photography or specular microscopy.

This FAQ addresses the following:

1. Does Medicare cover endothelial cell count performed with a specular microscope?
2. What is Medicare’s coverage policy?
3. Are there any limitations on coverage?
4. Is the physician’s presence required while the test is being performed?
5. Will ECC be reimbursed if performed on the same day as an eye exam or another diagnostic test?
6. What documentation is required in the medical record to support claims for ECC?
7. How much does Medicare allow for this test?
8. How often may this test be repeated on a patient?
9. If coverage of ECC is unlikely or uncertain, how should we proceed?

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