CommercialCoverageMedium impact
07.13.07l, Corneal Pachymetry Using Ultrasound
Independence Blue Cross·Ophthalmology, Optometry·Medical Policy
Effective date
Oct 1, 2025
We identified it
Jun 19, 2026
Summary
Independence Blue Cross has reissued corneal pachymetry policy 07.13.07l as part of annual review (effective 10/01/2025). The current version supersedes prior iterations; notably, a large set of ICD-10 diagnosis codes for 'unspecified eye' conditions were removed on 09/19/2022. Billing teams must ensure claims align with the current covered indications and use only CPT 76514 without modifier 50, as it is billed as a bilateral procedure.
Action Required
By 10/01/2025: Billing team must verify that all corneal pachymetry claims (CPT 76514) are submitted with documentation supporting one of the covered medical necessity criteria listed in the policy (e.g., endothelial cell dysfunction, corneal edema, transplant assessment, glaucoma risk assessment, or corneal thinning/ectasia diagnosis). Do NOT bill CPT 76514 for refractive surgery evaluation, routine screening without clinical suspicion, routine preoperative cataract evaluation without known endothelial disease, or repeat glaucoma testing. Update billing software to enforce the 'performed once per lifetime' limitation and ensure modifier 50 is never appended to CPT 76514. Audit recent claims submitted with the removed ICD-10 codes (H18.10, H18.219, H40.009, H40.1190, etc.) and resubmit with appropriate billable diagnosis codes if the clinical scenario supports coverage. Failure to comply will result in claim denials and potential recovery of previously paid claims.