👁️ CPT 76512 — Ophthalmic Ultrasound, Diagnostic; B-Scan (With Or Without Superimposed Non-Quantitative A-Scan)
Quick Reference
wRVU: 0.29 | Global Period: XXX (Diagnostic Test / 0 Days) | Assistant Payable: ❌ No | Bilateral Indicator: 3 Rule: A bilateral indicator of 3 means no payment reduction applies when the procedure is performed on both eyes in the same session — each side is reimbursed at 100% of the allowed amount, subject only to standard multiple-procedure rules where applicable. Because 76512 is a diagnostic radiology study rather than a surgical procedure, it carries no assistant-surgeon or co-surgeon applicability and is exempt from modifier -51 multiple-procedure reduction rules.
📋 Clinical Description
CPT 76512 describes a contact B-scan ophthalmic ultrasound, a non-invasive echographic study that produces a two-dimensional, cross-sectional image of the globe, vitreous cavity, and orbital soft tissue. A small handheld transducer probe is placed directly against the closed eyelid or topically anesthetized globe, and high-frequency sound waves are reflected off internal ocular structures to generate a real-time image on the display. This code may include a superimposed non-quantitative A-scan (a one-dimensional waveform overlay used to characterize tissue reflectivity) but does not require it — the descriptor’s “with or without” language means the A-scan overlay does not change code selection. 76512 is distinguished from 76510, which bundles a full quantitative A-scan measurement into the same encounter, and from 76511, which reports the quantitative A-scan alone without any B-scan imaging.
This procedure is most often ordered when a physical media opacity — a dense cataract, vitreous hemorrhage, or corneal scarring — prevents the ophthalmologist from directly visualizing the retina, choroid, or vitreous with a standard ophthalmoscope or slit-lamp biomicroscope. Vitreous hemorrhage (H43.10–H43.13) is the most common indication encountered in both outpatient retina clinics and inpatient consultation settings, since blood in the vitreous cavity obscures the fundus view and B-scan becomes the only reliable way to rule out an underlying retinal detachment or intraocular mass. When the diagnostic question is a suspected retinal detachment rather than a media opacity, the retinal detachment codes (H33.041, H33.042) — not the vitreous hemorrhage codes — should drive primary diagnosis selection if detachment is confirmed on the study.
This procedure may be performed in the following clinical contexts:
- Dense cataract precluding fundus exam — B-scan is used preoperatively to rule out posterior segment pathology (retinal detachment, mass, or dense vitreous debris) before cataract surgery is scheduled, since the surgeon cannot otherwise visualize the retina through the opacified lens.
- Vitreous hemorrhage of unclear etiology — Ordered emergently or urgently to determine whether the retina remains attached beneath the hemorrhage, which directly changes surgical urgency and management.
- Suspected choroidal or intraocular mass — B-scan characterizes lesion shape, internal reflectivity, and extent when direct visualization is limited or when a mass is incidentally noted and needs baseline documentation.
- Trauma with suspected globe rupture or intraocular foreign body — Performed cautiously (often with a closed-lid technique) in the emergency or inpatient trauma setting to assess posterior segment integrity without direct manipulation of an open globe.
- Post-vitrectomy or post-retinal-surgery follow-up with persistent opacity — Used to monitor for recurrent detachment, hemorrhage, or silicone oil/tamponade status when the operated eye cannot be adequately visualized clinically.
🔬 Anatomical & Procedural Considerations
| Variant | Mechanism | Key Notes |
|---|---|---|
| Contact B-scan (standard) | The transducer probe is placed directly against the closed eyelid (or topically anesthetized globe) and swept through multiple meridians to build a composite two-dimensional cross-sectional image of the vitreous, retina, choroid, and proximal orbit. Real-time dynamic imaging allows the examiner to assess mobility of vitreous opacities versus a fixed, taut retinal membrane. | The closed-lid contact technique is preferred in acute trauma or suspected open-globe cases to avoid direct pressure on a compromised globe. Documentation should specify which meridians were scanned and whether kinetic (dynamic) technique was used to differentiate mobile vitreous debris from a fixed retinal detachment. |
| B-scan with superimposed non-quantitative A-scan | A one-dimensional A-scan waveform is displayed simultaneously with the B-scan image to help characterize tissue reflectivity — useful for distinguishing a solid choroidal mass from vitreous hemorrhage based on internal echo pattern, without performing formal quantitative amplitude measurements. | This is still reported as 76512, not 76510, because the A-scan here is non-quantitative and only supplements the B-scan interpretation; it does not generate the separate measurement report required for the quantitative A-scan code family. |
| Immersion (water bath) technique | A water-filled scleral shell or standoff device is used instead of direct contact, most often for anterior segment structures. | 76512 refers specifically to the posterior segment contact technique; when the anterior segment/immersion approach or high-resolution biomicroscopy is used, 76513 is the correct code instead, and reporting 76512 for that technique is a coding error. |
Clinical Pearl
The single most important documentation element for 76512 is a clear statement of why direct visualization was not possible (e.g., “4+ vitreous hemorrhage precluding fundus view”) and a description of the sonographic findings by structure (vitreous, retina, choroid). Payers frequently deny or downcode ophthalmic ultrasound claims that lack medical necessity language explaining the obstructed view, so this should appear explicitly in the interpretation and report, not just in the referring diagnosis.
✅ Procedure Includes
- Topical anesthetic administration to the ocular surface when a direct-contact (non-lid) technique is used.
- Placement and manipulation of the ultrasound transducer across multiple scanning meridians of the affected eye.
- Real-time dynamic (kinetic) assessment of vitreous mobility versus retinal membrane fixation when clinically indicated.
- Superimposed non-quantitative A-scan overlay, when performed, for tissue reflectivity characterization.
- Physician interpretation and generation of a written diagnostic report describing findings by ocular structure.
- Image capture and permanent storage of representative B-scan images to support the interpretation.
❌ Excludes / Do Not Report Together
| Code | Description | Relationship to 76512 |
|---|---|---|
| 76510 | Ophthalmic ultrasound, diagnostic; B-scan and quantitative A-scan performed during the same patient encounter | NCCI bundles 76511 and 76512 into 76510 when both a B-scan and a quantitative A-scan measurement are performed at the same encounter — only 76510 is separately payable in that scenario. |
| 76511 | Ophthalmic ultrasound, diagnostic; quantitative A-scan only | 76511 reports quantitative A-scan measurement without B-scan imaging; it is mutually exclusive with 76512 for the same session because performing both together converts code selection to 76510. |
| 76513 | Ophthalmic ultrasound, diagnostic; anterior segment ultrasound, immersion (water bath) B-scan or high resolution biomicroscopy | 76513 is reserved for anterior segment immersion technique or ultrasound biomicroscopy; when the study targets the posterior segment via standard contact technique, 76512 is used. |
| 92225 / 92226 | Ophthalmoscopy with fundus photography | Not bundled by NCCI, but medical necessity should be independently documented for each service if both are performed the same day. |
| E/M Codes (99202–99215 / 92002–92014) | Office or hospital visit | 76512 is a diagnostic test without a global surgical package; a same-day E/M is billed on its own merits without requiring modifier -25 unless local payer policy specifically mandates it. |
Bundling Alert — Global Period Is XXX
A Global Period of XXX means there is no post-procedure global surgical package associated with 76512 — it carries no included follow-up visits, and any subsequent E/M encounter is billed independently on its own merits. The most common audit finding for this code family is reporting 76511 and 76512 as separate lines when both a quantitative A-scan and a B-scan were performed at the same encounter; NCCI edits will deny the component code, and MACs frequently flag repeat billing of 76512 without documented new clinical indication.
🌳 Code Tree — Radiology: Diagnostic Ultrasound (Head and Neck)
CPT 76506-76999 Radiology: Diagnostic Ultrasound Procedures
│
├── 76506-76509 General/Other Diagnostic Ultrasound (Non-Ophthalmic)
│ ├── 76506 Echoencephalography, real time with image documentation
│ └── 76509 Echocardiography, fetal, for cardiac malformation
│
├── 76510-76519 Diagnostic Ultrasound — Ophthalmic (Head and Neck)
│ ├── 76510 Ophthalmic ultrasound, diagnostic; B-scan and quantitative A-scan performed during the same patient encounter (Global: XXX)
│ ├── 76511 Ophthalmic ultrasound, diagnostic; quantitative A-scan only (Global: XXX)
│ ├── ▶▶ 76512 ◀◀ Ophthalmic ultrasound, diagnostic; B-scan (with or without superimposed non-quantitative A-scan) ← YOU ARE HERE (Global: XXX)
│ ├── 76513 Ophthalmic ultrasound, diagnostic; anterior segment ultrasound, immersion (water bath) B-scan or high resolution biomicroscopy (Global: XXX)
│ └── 76516 Ophthalmic biometry by ultrasound echography, A-scan (Global: XXX)
│
└── 76519 Ophthalmic biometry by ultrasound echography, A-scan; with intraocular lens power calculation💰 RVU & Reimbursement Profile
| Metric / Component | Value | 2026 CMS PFS Policy & Details |
|---|---|---|
| Work RVU (wRVU) | 0.29 | Direct physician work for interpretation and report generation. |
| Non-Facility PE RVU | 2.15 | Includes equipment costs, ultrasound probe, gel, and clinical staff time in office. |
| Facility PE RVU | 0.16 | Practice expense when study is performed in a facility setting (hospital/ASC). |
| Malpractice RVU | 0.06 | Allocated MP risk value. |
| Total Non-Facility RVU | 2.50 | Approx. **33.04 CF). |
| Total Facility RVU | 0.51 | Applies to professional interpretation component performed in facility. |
| PC/TC Split Indicator | 1 | -26 (Professional = 0.40 RVU) / -TC (Technical = 2.10 RVU). |
| Global Period | XXX | Diagnostic test (Global concept does not apply; 0 post-op days). |
| Bilateral Indicator | 3 | No bilateral payment reduction applies; each eye is reimbursed at 100% allowed amount. |
| Assistant Surgeon | 00 | ❌ Not payable — diagnostic imaging study. |
| Co-Surgeon / Team | 00 | ❌ Not applicable. |
| Modifier -51 Exempt | Yes | Diagnostic radiology test codes are exempt from standard surgical multiple-procedure reductions. |
| Supervision Level (TC) | 02 | Direct Supervision required in non-facility settings when performed by clinical staff. |
Bilateral Billing Rules
CPT 76512 carries a bilateral indicator of 3, meaning both eyes can be scanned and billed in the same session without the standard 150%/50% bilateral payment reduction that applies to indicator-1 codes. When both eyes require B-scan, the study should be reported either as a single line with modifier -50, or as two lines with modifiers -RT and -LT, each reimbursed at 100% of the allowed amount. Coders should confirm the receiving MAC’s preferred billing format, since some jurisdictions require the -50 single-line convention while others expect separate -RT/-LT lines with a units value of 2.
📜 Local Coverage Determinations (LCDs) & Coverage Policies
While no single National Coverage Determination (NCD) mandates exclusive coverage parameters for ophthalmic ultrasound, local Medicare Administrative Contractors (MACs) publish specific LCDs and companion Billing and Coding Articles governing 76512:
| MAC / Jurisdiction | Policy / Reference | Specific Coverage & Billing Guidance |
|---|---|---|
| First Coast Service Options (FCSO, J-N) | LCD L33904 (“B-Scan”) & Article A57666 | Covers 76510, 76512, and 76513; mandates clear documentation of view obstruction or suspected structural lesion. |
| Palmetto GBA (J-J / J-M) | LCD L34061 & Companion Articles | Sets specific ICD-10 indication groups and frequency expectations for diagnostic ophthalmic imaging. |
| Novitas Solutions (J-H / J-L) | LCD L35038 (“Ophthalmic Ultrasound”) | Details coverage criteria for dense cataracts, vitreous opacities, choroidal lesions, and retinal detachment workups. |
| CGS / WPS / NGS | Regional SCODI & Ophthalmic Echography Articles | Requires documentation of obstructed optical media or posterior segment pathology; caps routine frequency (typically up to 4x/year per eye for chronic conditions). |
Universal Coverage Criteria Across MACs
- Medical Necessity Requirement: Documentation must explicitly state why optical visualization (direct/indirect ophthalmoscopy or slit lamp) could not be performed (e.g., dense cataract, dense vitreous hemorrhage, hyphema, corneal opacity) OR document a specific posterior segment lesion requiring echographic measurement.
- Technical & Professional Split: When the diagnostic equipment is facility-owned, the physician bills 76512 with modifier -26, and the facility claims the technical component with modifier -TC.
- Non-Covered Services: Routine screening B-scans or studies performed when clear optical views permit direct examination are strictly non-covered.
🏷️ Modifier Reference
| Modifier | Name | When to Apply |
|---|---|---|
| -RT | Right Side | Applied when the B-scan is performed on the right eye only; required for unilateral studies to establish laterality and support bilateral indicator-3 billing when combined with a separate -LT line. |
| -LT | Left Side | Applied when the B-scan is performed on the left eye only; used the same way as -RT for laterality-specific billing on a separate claim line. |
| -50 | Bilateral Procedure | Applied when both eyes are scanned in the same session as a single billed line, consistent with the MAC’s preferred bilateral billing convention for indicator-3 codes. |
| -26 | Professional Component | Applied by the interpreting physician when the equipment and technical performance belong to a facility or separate entity, reflecting only the interpretation and written report. |
| -TC | Technical Component | Applied by the facility or practice that owns the ultrasound equipment and performs technical image acquisition when the interpreting physician bills separately with -26. |
| -59 | Distinct Procedural Service | Applied when 76512 is reported with another same-day ultrasound or imaging code and documentation supports a genuinely distinct anatomic site or separate diagnostic indication. |
| -76 | Repeat Procedure by Same Physician | Applied when the B-scan is medically necessary to repeat on the same day by the same physician (e.g., re-scan after initial equivocal findings); documentation must state the reason for repetition. |
| -77 | Repeat Procedure by Another Physician | Applied when a second physician repeats the B-scan on the same day for an independent clinical reason. |
Non-Applicable Modifiers
🩺 Common ICD-10-CM Pairings
Vitreous Hemorrhage (Most Common Indication)
| ICD-10 Code | Description | HCC? | Clinical Notes |
|---|---|---|---|
| H43.11 | Vitreous hemorrhage, right eye | ❌ No | Supports medical necessity for a right-eye B-scan when fundus view is obscured by hemorrhage. |
| H43.12 | Vitreous hemorrhage, left eye | ❌ No | Supports medical necessity for a left-eye B-scan when fundus view is obscured by hemorrhage. |
| H43.13 | Vitreous hemorrhage, bilateral | ❌ No | Use when hemorrhage is documented in both eyes; B-scan is typically performed on each eye separately with laterality modifiers. |
| H43.10 | Vitreous hemorrhage, unspecified eye | ❌ No | Query the ordering provider for laterality before billing to prevent laterality mismatch claim rejections. |
Retinal Detachment (When Confirmed on B-Scan)
| ICD-10 Code | Description | HCC? | Clinical Notes |
|---|---|---|---|
| H33.041 | Total retinal detachment, right eye | ❌ No | Confirmed finding when B-scan demonstrates a fixed, taut retinal membrane; drives urgent surgical intervention. |
| H33.042 | Total retinal detachment, left eye | ❌ No | Left-eye confirmed finding; sequencing reflects the confirmed post-imaging diagnosis. |
| H33.043 | Total retinal detachment, bilateral | ❌ No | Bilateral total retinal detachment finding. |
Dense Cataract (Preoperative Clearance Indication)
| ICD-10 Code | Description | HCC? | Clinical Notes |
|---|---|---|---|
| H25.041 | Anterior subcapsular polar age-related cataract, right eye | ❌ No | Dense cataract obscuring posterior segment visualization in right eye. |
| H25.042 | Anterior subcapsular polar age-related cataract, left eye | ❌ No | Dense cataract obscuring posterior segment visualization in left eye. |
| H25.043 | Anterior subcapsular polar age-related cataract, bilateral | ❌ No | Dense cataract obscuring posterior segment view bilaterally; supports preoperative clearance B-scan. |
🏥 MS-DRG Considerations (Inpatient)
Inpatient Coding Reminder
CPT 76512 is a diagnostic test that does not itself drive MS-DRG assignment. When performed during an inpatient admission — for example, an ICU trauma patient with suspected vitreous hemorrhage or a postoperative retina patient with an obscured fundus view — the B-scan supports diagnostic workup and clinical management, but the case continues to group based on the principal diagnosis and any qualifying operating room procedures (e.g., open globe repair, vitrectomy under MS-DRGs 116/117).
🔧 ICD-10-PCS Equivalents (Inpatient Facility Coding)
Facility Inpatient Coding
Institutional facility coders assign an ICD-10-PCS code from the Imaging section (
B2) for inpatient ophthalmic ultrasound. Imaging-section codes do not affect MS-DRG grouping or CC/MCC capture.
| PCS Code | Full Description | Applicable Modality |
|---|---|---|
B240ZZZ | Ultrasonography, Eye, Right, No Contrast, No Qualifier | Standard contact B-scan, right eye |
B241ZZZ | Ultrasonography, Eye, Left, No Contrast, No Qualifier | Standard contact B-scan, left eye |
B244ZZZ | Ultrasonography, Eye, Bilateral, No Contrast, No Qualifier | Standard contact B-scan, both eyes same session |
PCS Character Analysis — B240ZZZ
| Position | Character | Value | Definition |
|---|---|---|---|
| 1 | Section | B | Imaging |
| 2 | Body System | 2 | Eye |
| 3 | Root Type | 4 | Ultrasonography |
| 4 | Body Part | 0 | Eye, Right |
| 5 | Contrast | Z | None |
| 6 | Qualifier | Z | None |
| 7 | Qualifier | Z | None |
📝 Coding Examples
Example 1 — Office: Vitreous Hemorrhage Obscuring Fundus View
Clinical Scenario: A 68-year-old male with proliferative diabetic retinopathy presents with sudden vision loss in the right eye. Dilated fundus exam is impossible due to a dense 4+ vitreous hemorrhage. The ophthalmologist performs a contact B-scan of the right eye, documenting mobile echogenic debris in the vitreous cavity with no evidence of a fixed retinal membrane or detachment. The report explicitly states the fundus view was completely obstructed by hemorrhage, necessitating ultrasound evaluation.
| Field | Code | Rationale |
|---|---|---|
| CPT | 76512--RT | Unilateral contact B-scan of the right eye; modifier -RT establishes laterality. |
| PDx | H43.11 | Vitreous hemorrhage, right eye — diagnosis matches clinical presentation and CPT laterality modifier. |
Example 2 — Outpatient Hospital: Bilateral B-Scan Preoperative to Cataract Surgery
Clinical Scenario: A 74-year-old female with dense mature bilateral cataracts is evaluated prior to cataract extraction. Because the posterior segment cannot be visualized through either opacified lens, the surgeon orders bilateral B-scans to rule out occult retinal pathology before scheduling surgery. Both eyes are scanned in the same outpatient encounter, confirming clear vitreous and attached retinas bilaterally.
| Field | Code | Rationale |
|---|---|---|
| CPT 1 | 76512--50 | Bilateral B-scan reported as a single line with modifier -50 (or separate -RT/-LT lines per MAC policy), reimbursed at 100% per eye under Bilateral Indicator 3. |
| PDx | H25.043 | Anterior subcapsular polar age-related cataract, bilateral — supports medical necessity for preoperative posterior segment clearance. |
Example 3 — Inpatient: Trauma Patient with Suspected Open Globe
Clinical Scenario: A 29-year-old male is admitted to the trauma ICU following severe blunt facial trauma with a hyphema and suspected open globe injury on the left. Direct fundoscopic exam is deferred to avoid globe compression. Ophthalmology performs a closed-lid contact B-scan to assess posterior segment integrity without applying pressure to the globe, identifying a moderate vitreous hemorrhage with an attached retina.
| Field | Code | Rationale |
|---|---|---|
| CPT | 76512--LT | Unilateral left-eye B-scan performed via closed-lid technique appropriate for suspected open globe. |
| PDx | H43.12 | Vitreous hemorrhage, left eye — reflects confirmed sonographic finding driving continued clinical monitoring. |
⚠️ Common Coding Pitfalls
- Billing 76511 and 76512 together instead of 76510: When both a quantitative A-scan and a B-scan are performed at the same encounter, NCCI rules mandate reporting 76510 rather than separately billing 76511 and 76512; billing both component codes triggers an automatic NCCI bundling rejection.
- Laterality mismatch between CPT modifier and ICD-10-CM code: The -RT/-LT/-50 modifier on the CPT line must agree with the laterality specified in the ICD-10-CM diagnosis code. Pairing -RT with H43.12 (left eye) creates an internally inconsistent claim.
- Confusing 76512 with 76513 for anterior segment studies: 76512 applies to posterior segment contact B-scans, whereas 76513 is reserved for anterior segment immersion (water bath) techniques or high-resolution biomicroscopy.
- Missing documentation of the obstructed-view indication: Payers require explicit documentation stating why direct visualization was not possible (e.g., “dense cataract precluding fundus view”); claims lacking this explanation are subject to medical necessity denials.
- Incorrect bilateral billing format for indicator-3 codes: Submitting a bilateral B-scan as two full-value lines without modifier designation or failing to follow MAC-specific bilateral submission rules can result in claim rejections.
📎 Sources
1 AMA CPT 2026 Professional Edition. 2 CMS CY2026 Medicare Physician Fee Schedule Final Rule (CMS-1832-F). 3 CMS RVU26A Relative Value Files. 4 NCCI Policy Manual for Medicare Services, Chapter IX (Radiology), 2025–2026. 5 ICD-10-CM Official Guidelines for Coding and Reporting FY2026. 6 ICD-10-PCS Official Guidelines for Coding and Reporting FY2026. 7 American Academy of Ophthalmology (AAO) Coding Guidelines for Ophthalmic Ultrasound. 8 CMS Medicare Coverage Database (MCD) — LCD L33904, L34061, L35038.Sources listed above correspond to superscript citations throughout this note. Verify all Medicare payment figures against your current CMS PFS Lookup tool and applicable MAC LCD prior to claim submission. Please use the latest AAPC/AHIMA Coding Books to verify each code within this note.