Reimbursement for Measuring Corneal Hysteresis (Reichert & AMETEK)

This monograph is designed to address the reimbursement issues associated with measurement of corneal hysteresis (CH) performed with Reichert’s Ocular Response Analyzer®.

While thickness and curvature of the cornea are well known measures, the biomechanical properties of the cornea are not commonly measured.  CH provides a measure of the viscoelasticity of the cornea.  It is useful: in identifying the risk of glaucoma development and progression, as a predictor of the effectiveness of glaucoma therapy, for evaluating the accuracy of IOP measurements, in detection of abnormal corneal conditions, and assessing the potential for complications following corneal refractive surgery.  Since technology advances faster than the coverage and payment policies of Medicare and other third party payers, ophthalmologists and optometrists may experience frustration with reimbursement issues related to newly-established CPT codes.

Much of the information is taken from official publications of the Medicare program, including the Centers for Medicare & Medicaid Services (CMS) and the Medicare Administrative Contractors (MAC).  However, the reader is encouraged to check with the local MAC for additional information and instructions.  In the case of other third party payers, we have used the coding concepts contained in Current Procedural Terminology (CPT) and published by the American Medical Association; diagnosis codes are from International Classification of Diseases, 9th Revision (ICD-9-CM), and 10th Revision (ICD-10-CM).

In this document, we identify the relevant codes and coverage issues associated with CH measurement.  At this time, formal coverage policies for measuring CH are few.  In the absence of a published policy, coverage is determined on a case-by-case basis at the discretion of the payer.


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 Provided Courtesy of Reichert Inc. & AMETEK Inc.


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