CPT 76510Radiology

Oph us dx b-scan&quan a-scan

CPT 76510 covers an ophthalmic ultrasound examination that uses two techniques together: a B-scan (which creates cross-sectional images of the eye) and a quantitative A-scan (which measures the eye's internal structures with precise numerical data).

Showing rates for

National Average

Base Medicare rate

$65.66

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

0.7

PE RVU (NF)

1.31

MP RVU

0.02

Total RVU

2.03

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Document both the B-scan images and quantitative A-scan measurements explicitly in the report to support medical necessity for 76510 rather than 76511 (B-scan only) or 76519 (A-scan only)
Impact: Prevents downcoding to 76511 ($45-55 range) or 76519 ($35-45 range), protecting approximately $15-25 per claim
Bill with appropriate laterality modifiers (RT, LT, or bilateral approach per payer) for each eye examined, as most payers reimburse per eye
Impact: Bilateral documentation can increase reimbursement to $98.49-131.32 (150% payment) versus single eye at $65.66
Link to specific ICD-10 codes documenting media opacity, suspected posterior segment pathology, or pre-operative evaluation to establish medical necessity
Impact: Reduces denial rate by 30-40% when proper diagnosis codes justify need for ultrasound versus direct examination
Verify whether your facility bills global service or split billing (26/TC); avoid duplicate billing that triggers recoupment
Impact: Prevents 100% payment recoupment on incorrectly split claims; global rate is $65.66, components must total same amount
Capture and store representative B-scan images and A-scan tracings with measurements as part of the permanent medical record for audit protection
Impact: Essential for audit defense; missing documentation results in 100% recoupment during post-payment review
For Medicare patients, ensure the service is billed within the timely filing limit (typically 12 months) and meets LCD/NCD criteria for ophthalmic ultrasound
Late filing results in automatic denial with no appeal rights; non-covered indications result in patient liability issues

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Frequently asked questions

What is the difference between CPT 76510 and 76511?

CPT 76510 requires both B-scan ultrasonography AND quantitative A-scan measurements to be performed and documented, while CPT 76511 is for B-scan only without quantitative A-scan. If only B-scan is performed, use 76511. The quantitative component must include specific numerical measurements of eye structures.

How much does Medicare pay for CPT 76510 in 2025?

The 2025 Medicare national average reimbursement for CPT 76510 is $65.66 for both facility and non-facility settings. This rate is based on 2.03 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary by geographic locality.

Can CPT 76510 be billed bilaterally?

Yes, CPT 76510 can be billed for bilateral examinations. Billing methodology varies by payer - some accept modifier 50 for 150% payment, while others require two separate line items with RT and LT modifiers. Always verify payer-specific bilateral billing policies before submitting claims.

What diagnosis codes support medical necessity for CPT 76510?

Common supporting diagnoses include cataracts (H25-H26 series), vitreous hemorrhage (H43.1), suspected retinal detachment (H33 series), media opacities preventing visualization (H16-H18 for corneal conditions), ocular trauma (S05 series), and pre-operative evaluation for intraocular lens calculation. The diagnosis must justify why ultrasound is needed versus direct examination.

Do I need a modifier 26 or TC when billing CPT 76510?

Use modifier 26 when billing only the professional component (physician interpretation), modifier TC when billing only the technical component (equipment/technician), or no modifier when billing the global service (both components). Incorrect splitting can result in overpayment recoupment, so verify your facility's billing arrangement.

How many RVUs is CPT code 76510 worth?

CPT 76510 has 2.03 total RVUs in 2025, consisting of 0.7 work RVU, 1.31 practice expense RVU (both facility and non-facility), and 0.02 malpractice RVU. These RVUs are multiplied by the conversion factor to determine Medicare payment.

Can CPT 76510 be billed with an office visit on the same day?

Yes, CPT 76510 can be billed with an E/M service (office visit) on the same day if both are medically necessary and separately documented. The ultrasound should be distinct from the routine examination. Some payers may require modifier 25 on the E/M service to indicate a significant, separately identifiable evaluation was performed.