CommercialBilling CodesMedium impact
07.13.07m, Corneal Pachymetry Using Ultrasound
Independence Blue Cross·Ophthalmology, Optometry·Medical Policy
Effective date
Oct 1, 2025
We identified it
Sep 3, 2026
Summary
Independence Blue Cross reissued policy 07.13.07m for corneal pachymetry (CPT 76514) with no substantive changes, but added three new ICD-10 diagnosis codes (H40.841, H40.842, H40.843) effective 10/01/2025 to expand glaucoma-related coverage criteria. Billing teams must ensure claims for these glaucoma diagnoses are coded correctly and meet medical necessity requirements for IOP assessment.
Action Required
By October 1, 2025: Billing team must update billing software and claim submission processes to recognize ICD-10 codes H40.841, H40.842, and H40.843 as medically necessary when paired with CPT 76514 for corneal pachymetry. Ensure providers document that the procedure is being performed specifically to determine the influence of corneal thickness on IOP measurements in individuals with suspected or established glaucoma (per policy guidelines). Note that repeat testing on individuals with established glaucoma remains NOT medically necessary. Update encounter forms and clinical documentation templates to capture the glaucoma-related diagnosis codes. Verify that claims submitted with these diagnosis codes include appropriate medical necessity documentation. Claims lacking proper documentation or submitted for screening purposes only will be denied.