76519

🎯 CPT 76519 — Ophthalmic Biometry by Ultrasound Echography, A-scan; with Intraocular Lens Power Calculation

Code Overview

CPT 76519 describes ophthalmic biometry by ultrasound A-scan with intraocular lens (IOL) power calculation — the complete pre-cataract-surgery diagnostic service that combines ultrasonic measurement of the eye’s axial length with the mathematical application of an IOL power calculation formula to determine the appropriate power of the artificial lens to be implanted during cataract extraction. It is the ultrasound-based standard for IOL planning and is the designated code when optical biometry (CPT 92136) cannot obtain a reliable measurement — most commonly because of a dense cataract that blocks the light beam of the optical biometer.

CPT 76519 has one of the most nuanced and compliance-critical billing structures in all of ophthalmology. Its technical component (TC) carries Bilateral Indicator 2 (inherently bilateral — billed once regardless of whether one or both eyes are scanned), while its professional component (-26) carries Bilateral Indicator 3 (inherently unilateral — billed once per eye, per interpretation, using eye-specific modifiers). This asymmetric bilateral structure makes it among the most frequently miscoded diagnostic codes in ophthalmology. Additionally, CPT 76519 is NCCI mutually exclusive with CPT 92136 — the two IOL biometry codes can never be separately reimbursed at the same patient encounter, regardless of which modifier is applied.

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Full Code Description

Element	Detail
CPT Code	76519
Full Descriptor	Ophthalmic biometry by ultrasound echography, A-scan; with intraocular lens power calculation
Section	Diagnostic Ultrasound, Head and Neck
System	Eye and Ocular Adnexa — Diagnostic Imaging
Global Period	XXX — Does not apply (diagnostic/radiology procedure)
wRVU (global)	~0.74
wRVU (-26 professional component)	~0.37
wRVU (-TC technical component)	~0.37
Non-Facility Total RVU (global)	~1.58
Facility Total RVU (global)	~0.91
Non-Facility RVU (-26 only)	~0.56
Non-Facility RVU (-TC only)	~1.02
Medicare ~Payment (global, 2025)	~$28-$34 (geographically adjusted)
Medicare ~Payment (-26, per eye)	~$12-$15
Bilateral Indicator — TC	2 — Inherently bilateral; billed once; no -50, -RT, -LT
Bilateral Indicator — -26	3 — Inherently unilateral; billed per eye with -RT or -LT
Bilateral Indicator — Global	2 — Inherently bilateral for TC portion; see mixed billing rules
Assistant Surgeon	Not applicable
Telehealth	No
Supervision Level (TC)	General supervision (Level 1)
ASC Eligible	Yes

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Clinical Description

The Role of Biometry in Cataract Surgery

Cataract surgery (CPT 66984, 66982) involves the removal of the patient’s natural crystalline lens and replacement with a synthetic intraocular lens (IOL). The refractive outcome of cataract surgery — whether the patient will be emmetropic (no spectacle needed for distance), mildly myopic (preferred for monovision strategies), or otherwise — is determined primarily by the power of the IOL selected and implanted. Incorrect IOL power results in residual refractive error requiring spectacle correction or, in significant cases, IOL exchange surgery.

IOL power calculation is the mathematical process of determining the appropriate IOL power for a given eye. It requires precise measurement of the eye’s biometric parameters — primarily axial length and corneal curvature (K readings) — and the application of a calculation formula that predicts the resultant refraction based on these measurements and the expected position of the IOL within the eye.

CPT 76519 describes the A-scan ultrasound method of biometry — the acquisition of axial length and other biometric parameters using ultrasound, combined with the IOL power calculation. This is the complete pre-surgical biometry service in one code.

Understanding the Two Methods of IOL Biometry

Method	Technology	CPT Code	Preferred Use
Ultrasound A-scan	Sound waves (10 MHz), contact or immersion	76519	Dense/brunescent cataracts; when optical biometry fails; historical standard
Optical coherence biometry (OCB)	Partial coherence interferometry, infrared light	92136	First-line for most patients; superior accuracy; non-contact; cannot penetrate dense cataracts

Clinical principle: CPT 92136 (IOLMaster, Lenstar, Anterion) has replaced CPT 76519 as the preferred first-line biometry method in most modern cataract practices due to its superior accuracy (axial length measurement precision ~0.01-0.02 mm vs. ~0.05-0.3 mm for contact A-scan), non-contact nature, and simultaneous acquisition of corneal curvature and other parameters. However, optical biometry cannot penetrate the opacified lens of a very dense (brunescent, white, or posterior subcapsular) cataract — in those cases, ultrasound A-scan (CPT 76519) becomes the only viable biometry option.

A-scan Ultrasound Biometry — Technique for CPT 76519

Physics:
A piezoelectric transducer emitting focused 10 MHz ultrasound pulses is directed along the optical axis of the eye. Sound waves travel through the ocular media and reflect at tissue interfaces (cornea, anterior lens surface, posterior lens surface, vitreoretinal interface), returning echoes to the transducer. The time delay between emission and echo is converted to distance using the known speed of sound through each tissue type:

• Cornea and crystalline lens: ~1641 m/s

• Aqueous and vitreous: ~1532 m/s

• Average for a phakic eye: ~1548-1555 m/s (immersion technique default)

Contact applanation technique:
The probe is placed directly on the anesthetized corneal surface. Risk: corneal compression artificially shortens the apparent axial length by 0.1-0.3 mm (yielding an IOL power error of approximately 0.25-0.75 D). The contact method is faster and more convenient but less accurate than immersion.

Immersion technique:
A fluid-filled scleral shell (Prager shell) is placed over the anesthetized eye, creating a water bath in which the probe floats without corneal contact. Eliminates compression artifact; provides superior reproducibility and accuracy. Immersion technique is considered the ultrasound gold standard for biometry and is preferred whenever possible.

IOL power calculation formulas:
After the A-scan measurements are obtained, the technician or ophthalmologist inputs the biometric data into an IOL power calculation formula. The formula predicts the IOL power needed to achieve the desired post-operative refraction. Major formulas include:

Formula	Generation	Best For	Notes
SRK/T	3rd generation	Normal axial lengths	Most widely used older formula; less accurate at extremes
Hoffer Q	3rd generation	Short eyes (AL < 22 mm)	Preferred for nanophthalmos, hyperopia
Holladay 1	3rd generation	Average eyes	Good general-purpose formula
Holladay 2	4th generation	Wide range	Incorporates more biometric variables
Haigis	4th generation	Short and long eyes	Uses 3 constants; requires good A-constant optimization
Barrett Universal II	5th generation	All eyes; best current accuracy	Incorporates lens factor; superior for long eyes
Kane formula	AI-based	All eyes	Machine learning-based; excellent accuracy
Hill-RBF	AI-based	All eyes	Radial basis function; pattern recognition-based

The professional component (-26) of CPT 76519 — performed by the interpreting physician — encompasses the review of the A-scan waveforms for quality and accuracy, confirmation of axial length and other biometric measurements, selection and application of the IOL formula, target refraction determination, IOL power recommendation, and documentation of the written interpretation report. This represents meaningful physician cognitive work beyond mere data collection.

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The Asymmetric Bilateral Structure of CPT 76519

This is the most clinically critical and compliance-relevant aspect of 76519 billing. The code’s TC and professional (-26) components have different bilateral indicators — creating a coding structure unlike most CPT codes.

Technical Component (TC) — Bilateral Indicator 2

The technical component of 76519 is designated BILAT Indicator 2 — meaning the RVUs assigned to the TC reflect the code being performed bilaterally. The TC covers the physical performance of the A-scan scan on the eye(s). Because pre-cataract biometry almost always involves scanning both eyes (even if surgery is planned for only one eye — the fellow eye measurements provide a reference point and the scan is typically performed on both), the TC is priced as a bilateral service.

Rules for TC billing:

• Report 76519-TC exactly once per session, regardless of whether one or both eyes are scanned

• Never add Modifier -50, -RT, or -LT to 76519-TC — the TC is already priced as bilateral

• If only one eye is scanned (unilateral TC), report 76519-TC-52 (reduced services; TC first in modifier field; -52 second)

Professional Component (-26) — Bilateral Indicator 3

The professional component is designated BILAT Indicator 3 — meaning the RVUs assigned to the -26 reflect a unilateral service (interpretation of one eye). The -26 represents the physician’s work of reviewing and interpreting the biometric data and generating the IOL power calculation for a specific eye. Each eye’s interpretation is a separate cognitive professional act.

Rules for -26 billing:

• When IOL power calculation is performed for one eye only: report 76519-26-RT (or -LT) — 1 unit

• When IOL power calculation is performed for both eyes on the same day: report 76519-26 — 2 units (quantity = 2; per Palmetto GBA guidelines, NOT using -RT and -LT with quantity 2, or alternatively two separate line items with -RT and -LT respectively — verify per your specific MAC)

• Never report 76519-26 with Modifier -50

• Each eye’s interpretation requires its own eye-specific laterality modifier when billing separately

Global Code (No Component Modifier) — Bilateral Indicator 2

When the same provider performs both the TC and the -26, the global code (76519, no modifier) reflects the TC being bilateral but the -26 being unilateral (one eye):

• Billing 76519 globally (no modifier) = bilateral TC + one eye’s professional interpretation

• If the second eye’s IOL calculation is also performed, add 76519-26 (quantity 1 additional, with -RT or -LT as applicable) as a second line item

This creates the somewhat counterintuitive situation where billing for both eyes’ IOL calculations on the same day requires two separate line items even for a provider doing everything globally:

• Line 1: 76519 (global — bilateral TC + one eye’s -26)

• Line 2: 76519-26 with the second eye’s laterality modifier (quantity 1)

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The Asymmetric Bilateral Billing Table (Palmetto GBA Reference)

Procedure Performed	CPT Code	Modifier(s)	Quantity
Bilateral TC + unilateral -26 (standard single-eye IOL calc)	76519	None	1
Bilateral -TC only	76519	TC	1
Bilateral -26 (both eyes’ IOL calculation same day)	76519	26	2
Unilateral TC only	76519	TC 52	1
Unilateral -26 (one eye)	76519	26	1
Unilateral TC + unilateral -26 (one eye, global)	76519	52	1
Bilateral TC + bilateral -26 (both eyes IOL calc, same day, split billing)	76519-TC (qty 1) + 76519-26 (qty 2)	TC / 26	1 + 2

Note

Modifier field order is mandatory: Per Palmetto GBA and CMS billing guidelines, when both a component modifier (TC or -26) and -52 apply, the component modifier must appear in the first modifier field and -52 in the second. Reversed order causes claim processing errors.

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CPT Code Tree — Ophthalmic Biometry and Diagnostic Ultrasound

Diagnostic Ultrasound — Head and Neck (76506-76536)
  └── Ophthalmic Ultrasound / Biometry
        │
        ├── 76510    Ophthalmic ultrasound; contact B-scan ± A-scan
        │            (Posterior segment imaging — vitreous, retina, choroid, masses;
        │             dense cataract posterior evaluation; BILAT Ind. 1; use -RT/-LT/-50)
        │
        ├── [[76511]]    Quantitative A-scan only (diagnostic; NOT biometry)
        │            (Tissue characterization, mass height measurement — tumors;
        │             BILAT Ind. 1; use -RT/-LT/-50)
        │
        ├── [[76512]]    Contact B-scan (posterior segment)
        │
        ├── [[76513]]    Anterior segment ultrasound — immersion or UBM
        │            (High-resolution anterior segment imaging; ciliary body, angle,
        │             IOL position; BILAT Ind. 1; use -RT/-LT/-50)
        │
        ├── [[76516]]    Ophthalmic biometry A-scan (WITHOUT IOL calculation)
        │            (Axial length measurement only; myopia monitoring; buphthalmos;
        │             tumor follow-up; BILAT Ind. 2 all components; use -52 if unilateral)
        │
        ├── 76519    Ophthalmic biometry A-scan WITH IOL power calculation    ◄ THIS CODE
        │            (Complete pre-cataract biometry — A-scan + IOL formula;
        │             TC = BILAT Ind. 2; -26 = BILAT Ind. 3; wRVU ~0.74 global;
        │             NCCI mutually exclusive with 92136; 12-month frequency limit)
        │
        └── [[92136]]    Ophthalmic biometry by partial coherence interferometry
                     WITH IOL power calculation (IOLMaster, Lenstar, Anterion)
                     (Optical biometry — first-line IOL planning; TC = BILAT Ind. 2;
                      -26 = BILAT Ind. 3; NCCI mutually exclusive with 76519;
                      wRVU ~0.69 professional; preferred modality when feasible)

Critical 76519 vs. 92136 Decision Tree

Pre-cataract biometry needed
    │
    ├── Can optical biometry (IOLMaster/Lenstar) obtain reliable signal?
    │       │
    │       ├── YES → Use 92136 (optical biometry with IOL calculation)
    │       │          First-line; superior accuracy; non-contact
    │       │
    │       └── NO → Dense/brunescent cataract prevents light penetration?
    │                   │
    │                   └── YES → Use 76519 (A-scan with IOL calculation)
    │                              Document: "Optical biometry attempted but
    │                              failed due to dense cataract; A-scan
    │                              performed as alternative method"
    │
    └── Cannot report BOTH 76519 AND 92136 at same session → NCCI "0" edit
        → If both attempted same session, report ONLY 92136

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Includes / Excludes Notes

What Is Included in CPT 76519

Technical Component (TC) includes:

• Patient preparation and positioning

• Topical anesthetic instillation (contact technique)

• Immersion shell or scleral cup placement (immersion technique)

• A-scan probe setup and equipment calibration

• Ultrasound waveform acquisition (multiple measurements per eye for reproducibility — typically 5-10 measurements per eye)

• Recording and averaging of axial length, anterior chamber depth, lens thickness, vitreous chamber depth

• Data storage and printout generation

Professional Component (-26) includes:

• Review of A-scan waveform quality (spike morphology, alignment, reproducibility)

• Assessment of measurement accuracy and outlier exclusion

• Entry of biometric data into IOL power calculation formula

• Target refraction selection (emmetropia, mini-monovision, full monovision target)

• Application of selected IOL formula (SRK/T, Barrett, Hoffer Q, Holladay, Kane, etc.)

• IOL power recommendation (primary and backup IOL choices)

• Formal written interpretation report documenting measurements, formula used, and IOL recommendation

• Signature and attestation by the interpreting provider

What Is NOT Included

• Corneal topography or keratometry — K-readings used in IOL formulas are typically obtained separately via manual keratometry (no CPT), automated keratometry (included in refraction exam), or corneal topography (92025); the K data is input into the formula but obtaining K-readings is a separate step; for A-scan biometry (76519), the K-readings must come from a separate source and are not embedded in 76519 unlike 92136

• B-scan ultrasound (76510) — if posterior segment evaluation is needed (dense cataract precluding fundoscopy), 76510 may be separately reportable with documentation of distinct clinical indication

• Comprehensive eye examination (92014 or 92004) — separately reportable with documentation; the pre-cataract surgical decision exam is distinct from the biometry

• Office visit / E/M — separately reportable with Modifier -25 if significant, separately identifiable

NCCI Bundles and Mutual Exclusivities

Code	Relationship to 76519	Notes
92136	NCCI mutually exclusive — modifier indicator “0”	Medicare will ONLY reimburse 92136 when both are reported; cannot override with any modifier; applies globally, TC-only, and -26 combinations
76516	Not bundled; distinct code (no IOL calc)	Not typically reported together at same session — if IOL calc is performed, only 76519 applies
76510	Not bundled; separately reportable	B-scan for posterior segment evaluation has distinct indication; document separately
76511	Not bundled; separately reportable with distinct indication	Diagnostic quantitative A-scan for mass evaluation
76513	Not bundled; separately reportable with distinct indication	UBM anterior segment imaging
92025	Not bundled	Corneal topography separately reportable with appropriate diagnosis
66984	Not bundled	Cataract extraction (day of surgery) is separate; 76519 is pre-surgical; do not report biometry on the day of surgery unless genuinely performed separately

Note

92136 + 76519 NCCI mutual exclusivity — the critical rule: The NCCI assigns a modifier indicator of “0” to the 92136/76519 bundle. This means: (1) no modifier can override the edit; (2) if both codes are reported on the same claim for the same date of service, Medicare will automatically pay only 92136 (the Column 1 code); and (3) this applies to the global, -TC, and -26 combinations. Even if a practice legitimately performed optical biometry on one eye and A-scan on the other (because OCB succeeded on the right but failed on the left), the NCCI edit will only reimburse 92136. Practices in this situation should report only 92136 (per CMS guidance), although ASCRS and AAO have advocated for an edit change to allow reporting both when one eye requires each method.

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HCC (Hierarchical Condition Category) Mapping

CPT 76519 itself carries no HCC value — HCC mapping applies only to ICD-10-CM diagnosis codes.

ICD-10-CM	Description	HCC Mapping
H25.11	Age-related nuclear cataract, right eye	Not HCC mapped
H25.12	Age-related nuclear cataract, left eye	Not HCC mapped
H25.13	Age-related nuclear cataract, bilateral	Not HCC mapped
H25.21	Age-related anterior subcapsular cataract, right eye	Not HCC mapped
H25.81	Combined forms of age-related cataract, right eye	Not HCC mapped
H26.011	Infantile and juvenile nuclear cataract, right eye	Not HCC mapped
H26.10	Unspecified traumatic cataract	Not HCC mapped
H26.21	Cataracta complicata in neoplastic disease, right eye	Not HCC mapped (though neoplasm may)
H27.01	Aphakia, right eye	Not HCC mapped
E10.36	Type 1 DM with diabetic cataract	HCC 18
E11.36	Type 2 DM with diabetic cataract	HCC 19
H40.1112	POAG, right eye, moderate stage	Not HCC mapped
Q12.0	Congenital cataract	Not HCC mapped

Note

Risk adjustment documentation opportunity: When 76519 is performed for cataract surgery planning in a patient with diabetic cataract (E10.36, E11.36), the diabetes code with its ocular manifestation carries HCC 18 or 19 weight. This is substantially more specific and risk-accurate than coding simply “cataract” (H25.-) without the diabetic etiology. When diabetes is the cause of the cataract, always code the specific diabetic cataract code rather than the generic lens code — it is more accurate clinically and more complete for risk adjustment purposes.

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MS-DRG Mapping (Inpatient)

CPT 76519 is exclusively an outpatient/office procedure. Inpatient admission for biometry alone is not clinically indicated. The procedure is always performed in the ambulatory setting (physician office, clinic, ASC pre-op unit, HOPD outpatient) in preparation for subsequent cataract surgery.

The underlying cataract surgery (performed on a subsequent date) drives its own DRG when applicable. Cataract surgery is overwhelmingly outpatient/ASC and does not generate an MS-DRG in most cases.

When the patient is hospitalized for a concurrent, unrelated condition and the biometry is performed as an outpatient diagnostic service during the same episode, the DRG is driven by the inpatient diagnosis — not by the biometry.

MDC: MDC 02 — Diseases and Disorders of the Eye (if any inpatient admission occurs for the ocular condition)

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Medicare Coverage Policy — LCD L34181

Medicare LCD L34181 (and its companion billing article A57070) govern coverage for CPT 76519. Key provisions:

Covered Indications

Medicare covers 76519 when:

1. The patient has a documented cataract with a clinical decision by both patient and surgeon to proceed with cataract extraction and IOL implantation

2. The biometry is performed to determine the appropriate IOL power

3. Adequate documentation exists in the medical record, including:

   • Patient name and date of service

   • Indication for testing (cataract diagnosis)

   • Order for the test

   • A-scan waveform results

   • IOL power calculation report

   • IOL power recommendation

Coverage Limitations

Medicare frequency restrictions:

• Bilateral TC is covered once per cataract surgery episode per eye — when the TC is performed bilaterally for planning the first eye’s surgery, the TC cannot be rebilled when surgery on the second eye is later scheduled; only the -26 (additional interpretation) for the second eye is separately payable

• Per-eye -26 is covered once per eye within a 12-month period per the same provider/group without documented significant change in vision

• A second complete A-scan (TC + -26) is covered if performed by a different, unaffiliated surgeon for the second eye’s surgery who was not part of the group that performed the original scan

• If biometry is performed but surgery is later canceled or delayed, a repeat scan more than 1 year later is coverable; within 1 year, repeat biometry is coverable only with documentation of significant change in vision

Not Covered by Medicare

• 76519 is NOT covered when the only indication is a non-surgical cataract (patient not planning surgery)

• 76519 is NOT covered as a general “screening” or “baseline” axial length measurement without documented surgical plan

• 76519 is NOT routinely covered when performed by a provider who is not the operating surgeon or a coordinating provider unless medically justified

• Performing both 76519 and 92136 at the same session generates payment only for 92136

Supervision Requirements

Setting	Supervision Level Required
Physician’s office	General supervision (physician need not be present in the room; must be available) for non-physician technician performing the TC
Hospital outpatient department	General supervision; hospital incident-to rules apply
Incident-to billing	Technician-performed A-scan billed incident-to the physician requires direct supervision; if billing TC separately by facility, general supervision applies
Optometrist performing 76519	Optometrists may independently bill and perform biometry; no physician supervision required when optometrist is the interpreting provider

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ICD-10-CM Diagnosis Codes Commonly Paired With CPT 76519

Age-Related Cataracts (Most Common)

ICD-10-CM	Description	Notes
H25.11	Age-related nuclear cataract, right eye	Nuclear sclerosis — most common type
H25.12	Age-related nuclear cataract, left eye
H25.13	Age-related nuclear cataract, bilateral	When bilateral cataracts are the reason
H25.21	Age-related anterior subcapsular polar cataract, right eye
H25.22	Age-related anterior subcapsular polar cataract, left eye
H25.31	Age-related posterior subcapsular polar cataract, right eye	PSC — associated with steroids
H25.32	Age-related posterior subcapsular polar cataract, left eye
H25.811	Combined forms of age-related cataract, right eye	Multiple types in same lens
H25.812	Combined forms of age-related cataract, left eye
H25.9	Unspecified age-related cataract	Avoid — use specific type when documented

Cataracts of Other Etiology

ICD-10-CM	Description	Notes
H26.011	Infantile and juvenile nuclear cataract, right eye	Congenital/developmental
H26.012	Infantile and juvenile nuclear cataract, left eye
H26.111	Localized traumatic opacities, right eye	Post-traumatic cataract
H26.112	Localized traumatic opacities, left eye
H26.211	Complicated cataract, neoplastic disease, right eye
H26.212	Complicated cataract, neoplastic disease, left eye
H26.221	Complicated cataract with chronic iridocyclitis, right eye	Uveitic cataract
H26.222	Complicated cataract with chronic iridocyclitis, left eye
H26.31	Drug-induced cataract, right eye	Steroid-induced cataract
H26.32	Drug-induced cataract, left eye
H26.9	Unspecified cataract	Avoid when specific type is known

Diabetic Cataract (HCC-Relevant)

ICD-10-CM	Description	HCC	Notes
E10.36	Type 1 diabetes mellitus with diabetic cataract	HCC 18	Use instead of H25/H26 when DM is causative
E11.36	Type 2 diabetes mellitus with diabetic cataract	HCC 19	Most common diabetic cataract code
E13.36	Other specified diabetes mellitus with diabetic cataract	HCC 18

Aphakia (IOL Calculation After Lens Extraction Without Implant)

ICD-10-CM	Description	Notes
H27.01	Aphakia, right eye	Secondary IOL planning; patient had prior cataract surgery without IOL
H27.02	Aphakia, left eye
H27.03	Aphakia, bilateral

Congenital Lens Conditions

ICD-10-CM	Description	Notes
Q12.0	Congenital cataract	Pediatric congenital cataract
Q12.1	Congenital displaced lens
Q12.3	Congenital aphakia	Rare; absent crystalline lens

Secondary Diagnoses — Often Coded Concurrently

ICD-10-CM	Description	Notes
H40.1112	POAG, right eye, moderate	Document glaucoma if concurrent — affects surgical planning
H35.31-	Nonexudative AMD, right eye	Concurrent AMD affects expected visual outcome; document
H52.11	Myopia, right eye	High myopia affects IOL formula selection
H52.01	Hypermetropia, right eye	High hyperopia affects IOL formula selection
Z79.52	Long-term use of systemic steroids	Steroid-induced cataract context
Z96.11	Presence of IOL, right eye	Second eye planning; right eye already pseudophakic
Z96.12	Presence of IOL, left eye

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Billing and Modifier Guidance

The Core Asymmetric Billing Rules — Summary

Scenario	TC	-26	Notes
Scan both eyes; IOL calc one eye only	76519-TC (×1)	76519-26-RT or -LT (×1)	Standard unilateral IOL calc
Scan both eyes; IOL calc both eyes, same day	76519-TC (×1)	76519-26 (qty 2)	-26 quantity 2 OR two line items with -RT and -LT
Scan one eye only; IOL calc that eye	76519-TC-52 (×1)	76519-26-RT or -LT (×1)	-52 on TC for unilateral scan
Global billing; one eye IOL calc	76519 (×1)	—	Global = bilateral TC + unilateral -26
Global; both eyes IOL calc same day	76519 (×1) + 76519-26 (×1 with laterality)	—	Second eye calc requires additional -26 line
Second eye IOL calc on subsequent date	76519-26-LT or -RT (×1)	—	TC already paid; only -26 allowed on second encounter

The “Second Eye” Billing Scenario — Critical Compliance Point

Scenario: Patient had bilateral cataract evaluation. Right eye surgery was performed. Left eye surgery is now planned on a different date (e.g., 6 weeks later).

What is payable for the second eye:

• TC (76519-TC): NOT separately billable again — the TC was already paid as bilateral at the time of the original biometry session; rebilling the TC for the second eye constitutes duplicate billing

• -26 (76519-26-LT): Billable — the IOL power calculation for the left eye (interpretation of biometric data, formula application, IOL recommendation for the second eye) was not performed at the original session; this is a new professional service and is separately payable

Exception — unaffiliated second surgeon: If a different cataract surgeon (not affiliated with the group that performed the original biometry) operates on the second eye, that surgeon (or their group) may bill the TC as well as the -26 for a new scan, since they had no access to the original scan and need their own measurements. Document the separate entity clearly.

Frequency Limitation Rules

Situation	Payable?	Notes
Biometry performed, surgery scheduled	Yes	Standard indication
Biometry performed within 12 months — same provider/group	No (repeat TC)	Only allowed with documented significant change in vision
Surgery canceled; biometry > 1 year later	Yes — new scan	Adequate time elapsed
Surgery canceled; biometry < 1 year later when rescheduled	Yes, if significant vision change documented	Must document clinical change supporting redo
Second surgeon (unaffiliated) performs second eye surgery	Yes — full scan covered	Different entity; no access to original data

Site of Service Billing

Site	Billing Approach
Office (POS 11)	Non-facility RVUs; global billing if physician owns equipment and interprets; higher payment
HOPD (POS 22)	Physician bills -26 only; facility bills TC via UB-04; facility RVUs apply to physician
ASC	Physician bills -26 only; ASC bills facility fee; lower physician RVUs in facility setting
Optometry office	Optometrist may bill globally (owns equipment, performs scan, calculates IOL power)

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Coding Examples

Example 1 — Standard Pre-Cataract Biometry, One Eye Surgery Planned, Global Billing

Clinical Scenario:
A 71-year-old male with visually significant nuclear cataract OD presents for pre-surgical biometry. The ophthalmologist’s technician performs a contact A-scan bilaterally (both eyes scanned as standard protocol). The ophthalmologist reviews the waveforms, selects the Barrett Universal II formula, calculates the IOL power for the right eye targeting emmetropia, and recommends a +22.0 D IOL. The left eye measurements are obtained for reference but no IOL calculation is performed for the left eye as surgery is not planned.

ICD-10-CM:

• H25.11 — Age-related nuclear cataract, right eye (primary — operative eye)

• H25.12 — Age-related nuclear cataract, left eye (additional — bilateral cataracts documented; left eye measured as reference)

CPT (physician owns equipment — global billing):

• 76519 — Global; bilateral TC + unilateral -26 (right eye IOL calculation) (no modifier; report once; the code’s built-in bilateral TC covers the bilateral scan; the unilateral -26 covers the right eye IOL calculation)

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Example 2 — Pre-Cataract Biometry, Both Eyes IOL Calculation Same Day

Clinical Scenario:
A 68-year-old female has bilateral visually significant cataracts. The surgeon plans to operate on both eyes in the same week. The A-scan is performed bilaterally and IOL power calculation is performed for both eyes on the same day.

ICD-10-CM:

• H25.13 — Age-related nuclear cataract, bilateral

CPT (physician owns equipment, split billing for bilateral IOL calc):

• 76519-TC — Technical component, bilateral scan (1 unit; bilateral; no laterality modifier)

• 76519-26 — Professional component (quantity 2 — covers both eyes’ IOL calculations; OR two separate line items: 76519-26-RT qty 1 + 76519-26-LT qty 1 — verify per MAC)

Why quantity 2 (not Modifier -50) on the -26: The -26 has Bilateral Indicator 3 (inherently unilateral). When performing IOL calc for both eyes, the -26 is reported as quantity 2 (or two line items with laterality modifiers) — NOT with Modifier -50, which is improper for Bilateral Indicator 3 codes.

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Example 3 — Split Billing: Facility Technician Performs TC; Physician Interprets Only (-26)

Clinical Scenario:
A 75-year-old male presents to a hospital-based ophthalmology clinic for pre-cataract biometry before right eye surgery. The clinic’s ophthalmic technician (hospital employee) performs the contact A-scan bilaterally. The attending ophthalmologist later reviews the waveforms and waveform printout, selects the SRK/T formula for this patient with moderate axial length (23.8 mm OD), calculates IOL power for the right eye, and signs a formal written interpretation report. The hospital bills the TC; the ophthalmologist bills the -26.

ICD-10-CM:

• H25.11 — Age-related nuclear cataract, right eye

CPT:

• Hospital facility bill: 76519-TC — Technical component, bilateral scan (1 unit)

• Physician bill: 76519-26 — Professional component, right eye IOL calculation (1 unit; some MACs also accept -26-RT for clarity)

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Example 4 — Dense Brunescent Cataract: Optical Biometry Failed; A-scan Required

Clinical Scenario:
A 82-year-old female has a grade 4 nuclear sclerosis (brunescent) cataract OS preventing the IOLMaster 700 from obtaining a reliable measurement (signal-to-noise ratio inadequate; multiple attempts fail). The technician notes the failure in the record and proceeds to contact A-scan OS, successfully obtaining axial length and biometric measurements. The IOL power is calculated using the Hoffer Q formula (appropriate for this eye with axial length 20.9 mm — short eye, high hyperopia). No attempt is made to run the IOLMaster on the right eye (right eye was operated 3 months ago; pseudophakic).

ICD-10-CM:

• H25.12 — Age-related nuclear cataract, left eye

• Z96.11 — Presence of IOL, right eye (pseudophakic right eye — additional)

CPT:

• 76519-52 — Unilateral A-scan with IOL calculation, left eye (global, Modifier -52 for unilateral scan; TC performed left eye only; -26 performed left eye only; single line item with -52)

Tip

Documentation requirement: The record must document: (1) that optical biometry (IOLMaster or equivalent) was attempted and failed; (2) the reason for failure (dense brunescent cataract — insufficient signal); (3) that A-scan was performed as the alternative method. This documentation substantiates the use of 76519 rather than 92136 and supports the unilateral billing with -52.

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Example 5 — Second Eye IOL Calculation Only (-26 Only; TC Already Paid)

Clinical Scenario:
Six weeks ago, the same ophthalmologist performed bilateral A-scan with IOL calculation for this patient before right eye cataract surgery (76519 billed — bilateral TC + right eye -26). The right eye surgery was successful. The patient now returns for pre-operative planning for left eye cataract surgery. The surgeon reviews the original left eye A-scan measurements (already on file from 6 weeks ago) and calculates the IOL power for the left eye.

ICD-10-CM:

• H25.12 — Age-related nuclear cataract, left eye

CPT:

• 76519-26-LT — Professional component only, left eye IOL power calculation (1 unit; TC is NOT separately billable — it was already paid 6 weeks ago as bilateral; only the new interpretation/-26 for the left eye is payable)

Important

Critical pitfall avoided: Rebilling the TC (76519-TC) for the second eye is duplicate billing. The bilateral TC was already reimbursed at the first session. Only the -26 for the second eye’s IOL calculation is payable. Submitting a full new 76519 or a new 76519-TC for the second eye is an overpayment error and known audit target.

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Example 6 — Second, Unaffiliated Surgeon Performs New Scan for Second Eye Surgery

Clinical Scenario:
A patient had right eye cataract surgery with IOL implantation by Dr. Smith (Group A) 4 months ago. The patient moves to a new city and sees Dr. Jones (Group B — completely unaffiliated with Group A). Dr. Jones plans left eye cataract surgery and requires new biometry. Because Dr. Jones has no access to Group A’s measurements and is an independent entity, a new bilateral A-scan is performed and IOL power calculation is done for the left eye.

ICD-10-CM:

• H25.12 — Age-related nuclear cataract, left eye

• Z96.11 — Presence of IOL, right eye

CPT (Group B — full billing permitted for new scan):

• 76519-TC — Technical component, bilateral scan (1 unit; allowable because Group B is an unaffiliated entity that never billed for this patient’s prior scan)

• 76519-26-LT — Professional component, left eye IOL calculation (1 unit)

Important

Per LCD L34181: “A second complete A-scan/OCB will be covered if a different surgeon, unaffiliated with the surgeon who performed the first cataract extraction, performed the extraction on the second eye.” This is the single exception to the rule against rebilling the TC for the second eye.

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Example 7 — 76519 and 92136 Same Day — NCCI Prevents Separate Payment

Clinical Scenario:
A 77-year-old male presents for pre-cataract biometry OD. The technician performs the IOLMaster 700 (92136-TC). Results are obtained. Out of habit, the technician also performs a confirmatory contact A-scan (76519-TC). Both IOL calculations are documented. The practice attempts to bill both 92136 and 76519.

ICD-10-CM:

• H25.11 — Age-related nuclear cataract, right eye

What SHOULD be billed:

• 92136 — Optical biometry with IOL calculation (optical biometry succeeded; this is the only appropriate code)

• 76519 should NOT be billed — the NCCI mutual exclusivity (indicator “0”) means no modifier can allow separate payment; Medicare will only reimburse 92136

Note

Compliance note: Performing a confirmatory A-scan when optical biometry has already successfully obtained measurements is not supported as medically necessary and represents overbilling when both are submitted. The practice should bill only the modality that was clinically required for the IOL calculation.

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Example 8 — Diabetic Cataract, HCC-Relevant Coding

Clinical Scenario:
A 66-year-old female with Type 2 diabetes mellitus has a posterior subcapsular cataract OS causing significant glare and visual disturbance. The cataract is directly related to her long-standing diabetes. Pre-cataract A-scan biometry is performed for IOL power calculation.

ICD-10-CM:

• E11.36 — Type 2 diabetes mellitus with diabetic cataract (primary — HCC 19; the DM is the etiology of the cataract; use the diabetic combination code rather than separate cataract code when DM is causal)

• Z79.4 — Long-term current use of insulin (additional, if applicable)

CPT:

• 76519 — Global; bilateral TC + unilateral -26, left eye

HCC 19 documentation tip: When diabetes causes the cataract, using E11.36 (rather than H25.31 or H26.31) is both clinically more accurate and more complete for HCC risk adjustment — E11.36 maps to HCC 19, capturing the diabetes with its ocular complication. This carries meaningful risk adjustment weight that would be missed if only a generic cataract code is used.

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Key Coding Pitfalls & Tips

• Never use Modifier -50 with 76519-TC or 76519 global. The TC is Bilateral Indicator 2 — it is already priced as bilateral. Adding -50 will result in a 150% payment where only 100% is appropriate (overpayment) or may trigger claim rejection. This is one of the most common 76519 billing errors.

• Never use Modifier -50 with 76519-26. The -26 is Bilateral Indicator 3 — inherently unilateral per eye. The correct approach for bilateral IOL calculation is -26 with quantity 2 (or two separate line items with -RT and -LT), not -26-50.

• Never rebill the TC for the second eye (from the same group within 12 months). The bilateral TC was already reimbursed at the first biometry session. Submitting a new TC before the second eye’s surgery is duplicate billing — a known Medicare audit target for ophthalmology practices.

• 76519 and 92136 are NCCI mutually exclusive (indicator “0”) — no modifier overrides this. If both are submitted, Medicare pays only 92136. Never attempt to use Modifier -59 or any other modifier to separate these at the same session.

• Component modifier must be in the FIRST modifier field; -52 in the SECOND. Reversed modifier field order causes claim processing failures at the MAC and payer level.

• Document biometry failure when switching from 92136 to 76519. If optical biometry was attempted but failed (dense cataract), this must be explicitly documented in the medical record to support billing 76519. Without this documentation, payers may question why A-scan was used instead of the standard optical biometry method.

• Biometry should not be performed unless the patient has decided to have surgery. Per LCD L34181, the clinical standard is that biometry is performed after the mutual decision by patient and surgeon to proceed with cataract extraction. Pre-decisional “exploratory” biometry may be denied as not medically necessary.

• 12-month frequency limit applies to the same provider/group. Repeat A-scan within 12 months requires documented significant change in vision. Without this documentation, repeat claims will be denied as not medically necessary.

• Optometrists can independently perform and bill 76519. Optometrists working in coordination with cataract surgeons may perform the A-scan and IOL calculation and bill 76519 independently. However, the surgeon should not separately rebill 76519 for the same patient if adequate biometry data already exists from the optometrist’s study.

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Related Codes (Cross-Reference)

Code	Type	Description
92136	CPT	Optical biometry (IOLMaster/Lenstar) with IOL calc — NCCI mutually exclusive with 76519; first-line modality
76516	CPT	Ophthalmic biometry A-scan WITHOUT IOL calculation — myopia monitoring, non-IOL axial length
76510	CPT	Contact B-scan ± A-scan — posterior segment evaluation, dense cataract fundus imaging
76511	CPT	Quantitative A-scan — diagnostic tissue characterization (tumors, masses)
76513	CPT	Anterior segment UBM — anterior segment structure imaging
66984	CPT	Cataract extraction with IOL, routine — the surgery for which 76519 provides pre-op planning
66982	CPT	Cataract extraction with IOL, complex — same; complex cataract surgery
66985	CPT	Secondary IOL insertion — aphakia correction; biometry by 76519 supports this too
66986	CPT	Exchange of IOL — biometry by 76519 may support IOL exchange planning
92025	CPT	Corneal topography — separately reportable for K-measurements when indicated
92014	CPT	Comprehensive ophthalmic exam, established — pre-surgical exam; separately reportable
92004	CPT	Comprehensive ophthalmic exam, new patient — same
H25.11	ICD-10-CM	Age-related nuclear cataract, right eye
H25.12	ICD-10-CM	Age-related nuclear cataract, left eye
H25.13	ICD-10-CM	Age-related nuclear cataract, bilateral
H25.31	ICD-10-CM	Age-related posterior subcapsular cataract, right eye
H25.32	ICD-10-CM	Age-related posterior subcapsular cataract, left eye
H25.811	ICD-10-CM	Combined forms of age-related cataract, right eye
H25.812	ICD-10-CM	Combined forms of age-related cataract, left eye
H26.011	ICD-10-CM	Infantile and juvenile nuclear cataract, right eye
H26.111	ICD-10-CM	Localized traumatic opacities, right eye
H26.31	ICD-10-CM	Drug-induced cataract, right eye (steroid cataract)
H26.32	ICD-10-CM	Drug-induced cataract, left eye
E10.36	ICD-10-CM	Type 1 DM with diabetic cataract — HCC 18
E11.36	ICD-10-CM	Type 2 DM with diabetic cataract — HCC 19
H27.01	ICD-10-CM	Aphakia, right eye — secondary IOL planning indication
H27.02	ICD-10-CM	Aphakia, left eye
Q12.0	ICD-10-CM	Congenital cataract — pediatric biometry indication
Z96.11	ICD-10-CM	Presence of IOL, right eye — second eye planning context
Z96.12	ICD-10-CM	Presence of IOL, left eye

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Last Reviewed: 2026-02-18 | Source: AMA CPT Professional Edition 2025, CMS MPFS 2025, CMS LCD L34181 Ophthalmic Biometry for IOL Power Calculation, CMS Billing Article A57070, Palmetto GBA Ophthalmic Biometry and A-scan Coding Guidelines, CGS Medicare Ophthalmic Biometry Guidance (2012), AAPC Ophthalmology Coding Alert — Bilateral Rules Reference, ICD-10-CM FY2025