Mountain State Medical Policy Bulletin
Section: Radiology
Number: X-7
Topic: Ophthalmic Echography
Effective Date: August 1, 2005
Issued Date: August 1, 2005
Date Last Reviewed: 06/2005

General Policy Guidelines

Indications and Limitations of Coverage

Each ophthalmic echography procedure includes ultrasound studies of one or both eyes as well as a computer calculation. If separate charges are reported for each eye or for the calculation, the charges are combined and reimbursed under the appropriate ophthalmic echography code.

An ophthalmic ultrasound quantitative A-scan (code 76511) is a diagnostic study designed to uncover defects such as tumors or retinal detachments at the back of the eye which cannot be seen because of the presence of a cataract.

Ophthalmic biometry by ultrasound echography A-scan (code 76516) is a study done through the optical axis of the eye to determine the size and power of an intraocular lens (IOL) implant. Ophthalmic biometry by ultrasound echography with intraocular lens power calculation is reimbursed under code 76519. When both codes are reported at the same time, the services are combined and paid under code 76519.

If both studies (76511 or 76516 and 76519) are reported during the same session, the charges are reimbursed under code 76519.

Refer to Medical Policy Bulletin S-41 for additional information concerning ophthalmic echography performed in conjunction with corneal surgery.

Procedure Codes

765107651176512765137651676519
76529     

Traditional Guidelines

Refer to General Policy Guidelines

FEP Guidelines

Refer to General Policy Guidelines

PPO Guidelines

Refer to General Policy Guidelines

Managed Care POS Guidelines

Refer to General Policy Guidelines

Publications

References

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Glossary




This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.

Medical policies are designed to supplement the terms of a member's contract. The member's contract defines the benefits available; therefore, medical policies should not be construed as overriding specific contract language. In the event of conflict, the contract shall govern.

Medical policies do not constitute medical advice, nor the practice of medicine. Rather, such policies are intended only to establish general guidelines for coverage and reimbursement under Mountain State Blue Cross Blue Shield plans. Application of a medical policy to determine coverage in an individual instance is not intended and shall not be construed to supercede the professional judgment of a treating provider. In all situations, the treating provider must use his/her professional judgment to provide care he/she believes to be in the best interest of the patient, and the provider and patient remain responsible for all treatment decisions.

Mountain State Blue Cross Blue Shield (MSBCBS) retains the right to review and update its medical policy guidelines at its sole discretion. These guidelines are the proprietary information of MSBCBS. Any sale, copying or dissemination of the medical policies is prohibited; however, limited copying of medical policies is permitted for individual use.