CPT 76514Radiology

Echo exam of eye thickness

CPT code 76514 covers an ultrasound exam that measures the thickness of eye structures. This diagnostic imaging test helps doctors evaluate conditions like glaucoma, tumors, or other eye diseases by creating sound-wave images of the eye.

Showing rates for

National Average

Base Medicare rate

$11.00

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

0.14

PE RVU (NF)

0.18

MP RVU

0.02

Total RVU

0.34

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

NCCI bundling edits

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Billing tips

Verify bilateral billing policy with each payer before using modifier 50 versus RT/LT on separate lines
Impact: Prevents up to 50% payment loss ($5.50) when payer requires specific bilateral billing method
Document medical necessity clearly, linking pachymetry to specific diagnosis codes like glaucoma (H40.x) or pre-operative evaluation (Z01.00)
Impact: Reduces denial rate by 30-40% for this commonly audited low-cost procedure
Check NCCI edits before billing 76514 with comprehensive eye exams (92xxx codes) on same date
Impact: Prevents automatic denials; 76514 often bundles with evaluation codes unless modifier 59 is justified
Bill only once per eye per session regardless of number of measurements taken during single encounter
Impact: Avoids upcoding audits and potential recoupment of $11-22 per incident
Ensure technician-performed tests include physician interpretation documented within medical record same day
Impact: Prevents medical review denials requiring return of full $11 payment plus potential compliance investigation
For Medicare patients, verify LCD coverage requirements specific to your MAC jurisdiction for pachymetry indications
Impact: Some MACs limit coverage to specific diagnoses; non-covered claims result in 100% denial ($11 loss per claim)

Common denials

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 76514 in 2025?

The 2025 Medicare national average reimbursement for CPT 76514 is $11 for both facility and non-facility settings. This rate is based on 0.34 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary by MAC locality.

Can CPT 76514 be billed bilaterally for both eyes?

Yes, 76514 can be billed bilaterally when pachymetry is performed on both eyes. Use either modifier 50 (bilateral procedure) or bill two separate lines with RT and LT modifiers, depending on payer preference. Some payers reimburse 150% for bilateral procedures while others pay 100% per eye.

What is the difference between CPT 76514 and 92145?

CPT 76514 is an ultrasound-based pachymetry examination for measuring eye thickness, while 92145 is corneal hysteresis determination (biomechanical analysis). These are distinct procedures with different techniques and clinical applications. 76514 measures physical thickness while 92145 assesses corneal biomechanical properties.

Does CPT 76514 require a modifier 26 or TC?

Modifiers 26 (professional component) and TC (technical component) are only required when the professional and technical components are billed separately by different entities. If the same provider performs and interprets the test, bill 76514 without component modifiers for the global service.

How often can CPT 76514 be billed for the same patient?

There is no specific Medicare frequency limitation for 76514, but medical necessity must be documented for each service. Typical scenarios include baseline measurement, periodic monitoring (every 6-12 months for glaucoma), pre-operative assessment, or when clinical changes warrant repeat measurement. Frequent billing without clinical justification may trigger audits.

What diagnosis codes support medical necessity for CPT 76514?

Common supporting diagnoses include glaucoma (H40.x series), corneal disorders (H18.x), pre-operative evaluation (Z01.00 or Z01.01), contact lens fitting evaluation (Z46.0), and corneal edema (H18.2x). The diagnosis must demonstrate why corneal thickness measurement is clinically relevant to patient care.

Can optometrists bill CPT 76514 to Medicare?

Yes, optometrists can bill 76514 to Medicare within their scope of practice and state licensure. However, some Medicare Administrative Contractors have specific documentation requirements or coverage limitations for optometry services. Verify your local MAC policy and ensure proper credentialing with Medicare to avoid denial.