CPT Code 76513: Documentation & Billing Guide

🏥 76513: B-Scan; anterior segment ultrasound biomicroscopy (UBM)

⚡ Quick Reference

Metric	Value	Notes
Global	XXX	(Standard check)
wRVU	0.58 - Professional
Assist	No	(Standard policy)

🚧 Bundling & NCCI Edits

(What is INCLUDED in this code?)

Inclusives: Standard A-scans and B-scans performed on the same structures are generally bundled
Mutually Exclusive: - 76513 is bundled with 76512 (B-scan) under NCCI edits. If both are performed, only the more comprehensive service is typically paid unless a distinct clinical reason/different eye is documented (using Modifier -59 or laterality modifiers).
Explanation: Used for high-resolution imaging of structures behind the iris or for precise measurement of the anterior chamber angle when optical methods (like OCT) are limited by opaque media.

📝 MCW/Payer Specifics

Medical Necessity: Documentation must support Ophthalmology complexity.
Modifier -22: If applicable, look for >50% extra time/effort (e.g., BMI >40, extensive adhesions).
Category: This is a OPHTHALMOLOGY specific procedure.

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CPT Code Analysis: 76513

ICD-10-CM Code(s):

Common diagnosis codes supporting medical necessity for an anterior segment ultrasound (UBM) include:

H40.033 - Anatomical narrow angle, bilateral: To visualize the angle structures and confirm closure or plateau iris.
H21.503 - Unspecified adhesions of iris, bilateral: To evaluate iris cysts or tumors that cannot be visualized via slit lamp.
H40.60X4 - Glaucoma secondary to drugs, unspecified eye, indeterminate stage: Often used to decide on surgical intervention like peripheral iridotomy.

CPT/HCPCS Code(s):

76513 - Ophthalmic ultrasound, diagnostic; anterior segment ultrasound biomicroscopy (UBM), unilateral or bilateral: This procedure uses high-frequency sound waves (usually 35-50 MHz) to produce high-resolution images of the anterior segment of the eye, including the iris, ciliary body, and anterior chamber angle.

Code Specifications

WRVU: 0.58 (Professional Component) / 2.43 (Global/Total) for 2025.
Global Period: XXX (The global surgery concept does not apply to diagnostic tests).

Clinical Distinction: 76513 vs. 76512

Feature	76513 (Anterior Segment/UBM)	76512 (Diagnostic B-Scan)
Primary Target	Anterior chamber, iris, ciliary body.	Retina, choroid, vitreous, optic nerve.
Typical Use Case	Angle-closure glaucoma, iris tumors.	retinal detachment, vitreous hemorrhage.
Resolution	Very high (microscopic detail).	Moderate (gross anatomical detail).