CPT 76511Radiology

Oph us dx quan a-scan only

CPT code 76511 covers ophthalmic ultrasound A-scan testing, a diagnostic procedure that uses sound waves to measure the eye's internal structures, typically performed before cataract surgery to determine the power of the artificial lens implant needed.

Showing rates for

National Average

Base Medicare rate

$54.67

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

0.64

PE RVU (NF)

1.03

MP RVU

0.02

Total RVU

1.69

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

NCCI bundling edits

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Billing tips

Bill bilaterally using modifier 50 or two line items with LT/RT modifiers depending on payer preference
Impact: Billing correctly for bilateral procedures can increase reimbursement by $27.34 (from $54.67 to approximately $82.01) rather than risking denial
Document medical necessity when performed in addition to optical biometry (IOLMaster), such as dense cataracts preventing optical measurements
Impact: Prevents denials for duplication of services; ensures full $54.67 payment per eye when both methods are medically indicated
Do not bill 76511 on the same day as 76519 (B-scan) without clear separate medical necessity and documentation
Impact: Avoid bundling denials that could result in $54.67 payment reduction or recoupment
Verify whether payer requires prior authorization for A-scan performed separately from the cataract surgery package
Impact: Some managed care plans bundle A-scan into global surgical fees, risking $54.67 denial if billed separately
Ensure A-scan interpretation is documented in the medical record with specific measurements (axial length, ACD, lens thickness) and IOL calculation formula used
Impact: Complete documentation reduces audit risk and supports medical necessity; missing interpretation can trigger $54.67 recoupment
Bill on date of service performed, not the surgery date, especially if A-scan is done weeks before cataract surgery
Impact: Correct date of service prevents global period denials and ensures timely payment of $54.67

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 76511 in 2025?

The 2025 Medicare national average reimbursement rate for CPT 76511 is $54.67 for both facility and non-facility settings. This rate is based on a total RVU of 1.69 multiplied by the conversion factor of 32.3465. Local Medicare Administrative Contractors (MACs) may have slight geographic variations.

Can CPT 76511 and 92136 be billed together on the same day?

Yes, but only with clear documentation of medical necessity for both procedures. CPT 76511 (A-scan) and 92136 (optical biometry) measure similar parameters, so payers require documentation explaining why both were necessary, such as dense cataracts preventing accurate optical measurements or verification of unusual axial lengths. Without proper justification, one code will likely be denied as duplicate.

How do I bill CPT 76511 for bilateral A-scan procedures?

Bill bilateral A-scans either as a single line with modifier 50 (bilateral procedure) or as two separate lines with RT (right) and LT (left) modifiers, depending on payer preference. Medicare typically allows modifier 50 with 150% payment. Check with individual payers as some require two units on separate lines. Always verify the payer's specific billing guidelines for ophthalmic procedures.

What documentation is required to support medical necessity for CPT 76511?

Required documentation includes the medical indication (typically preoperative cataract evaluation), specific biometric measurements (axial length, anterior chamber depth, lens thickness), IOL power calculations with formula used, physician interpretation, and laterality. If performed with optical biometry, document why A-scan was additionally necessary. Include date, time, and physician signature on the interpretation.

Is CPT 76511 bundled into the cataract surgery global package?

This varies by payer. Traditional Medicare typically allows separate billing of 76511 when performed for preoperative planning, even if by the surgeon who will perform the cataract surgery. However, some Medicare Advantage and commercial payers bundle A-scan into the global surgical fee. Always verify the specific payer's policy and ensure A-scan is performed and billed before the global period begins.

What are the Work RVUs and Total RVUs for CPT code 76511?

For 2025, CPT 76511 has a Work RVU of 0.64, Practice Expense (PE) RVU of 1.03 (both facility and non-facility), and Malpractice (MP) RVU of 0.02, for a Total RVU of 1.69. These values are from the CMS Medicare Physician Fee Schedule RVU25A released December 23, 2024.

Who can perform and bill for CPT 76511?

CPT 76511 is typically performed and billed by ophthalmologists and, in some states, optometrists within their scope of practice. Technicians may perform the actual A-scan measurement under appropriate physician supervision, but a physician must provide and document the interpretation to bill for the service. The billing provider must have the necessary credentials and meet state licensing requirements for diagnostic ophthalmic ultrasound.