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Ophthalmic
Echography
The Centers for Medicare & Medicaid Services (CMS)
has clarified the payment policy for Ophthalmic
Echography, A-scan; with intraocular lens power
calculation CPT code (76519).
Technical Component Only
The technical component is typically performed on both
eyes on the same day. Therefore, the Medicare
reimbursement includes payment for the procedure being
performed on both eyes.
To bill the technical component, report code 76519
along with modifier TC. Do not report
modifier 50 (bilateral procedure) when
billing the technical component.
Professional Component Only
The intraocular lens (IOL) calculation, which is the
professional component, is performed for the eye for
which an IOL is planned. An IOL is not commonly required
for both eyes at the same time. Therefore, the Medicare
reimbursement amount for the professional component
includes the payment amount for the calculation of only
one eye.
To bill the professional component for one eye only,
report code 76519 along with modifier 26
(professional component). If IOLs are needed for both
eyes at the same time and the physician performs an IOL
calculation for both eyes on the same day, report
procedure code 76519 along with both modifier
26 and modifier 50.
Technical and Professional
Components
When both the technical and professional components
are performed and reported as a global service,
reimbursement includes payment for the technical
component performance on both eyes and the professional
(calculation) performance on one eye.
To bill for the global service, report procedure code
76519. Do not include modifier
50 in this situation.
If the provider performs an IOL calculation on both
eyes and performs the technical component on the same
day, report procedure code 76519 along with the modifiers
26 and 50 on one line;
and on the second line, report code 76519 along with
modifier TC.
Posted: 10/13/2004
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