Echo exam of eye
CPT code 76519 covers an ultrasound examination of the eye, used to visualize internal eye structures when direct examination is difficult or to measure specific eye components.
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
Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High
NCCI bundling edits
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Billing tips
Always append LT or RT modifier to specify which eye was examined, as payer edits increasingly require laterality for ophthalmic imaging codes
Impact: Prevents automatic denials and resubmissions, saving 15-20 days in payment cycle
For bilateral examinations, verify payer policy on modifier 50 versus billing two line items with LT/RT, as some carriers reject modifier 50 for ophthalmology codes
Impact: Correct bilateral billing methodology can mean difference between $65.99 and $98.99 reimbursement
Document specific clinical indication (dense cataract, vitreous hemorrhage, IOL calculation) rather than generic 'eye exam' to satisfy medical necessity requirements
Impact: Reduces denial rate by approximately 35% based on insufficient documentation claims
When performed on same day as comprehensive eye exam, ensure separate documentation exists for the ultrasound interpretation to support distinct service
Impact: Prevents bundling denials that would forfeit the $65.99 ultrasound reimbursement
Bill 76519 separately from A-scan (76516) when both are medically necessary, as these represent different ultrasound techniques with distinct diagnostic purposes
Impact: Captures full reimbursement for both services rather than losing $65.99 to incorrect bundling
Verify the performing technician has documented training/certification in ophthalmic ultrasound if billing technical component, as some auditors require competency evidence
Impact: Protects against recoupment demands during audits averaging $3,000-$5,000 per provider
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