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
Jun 19, 2026
Summary
Independence Blue Cross has reissued Policy 07.13.07m with no clinical content changes, but has added three new ICD-10 diagnosis codes (H40.841, H40.842, H40.843) effective 10/01/2025 as medically necessary for corneal pachymetry coverage. The policy continues to cover corneal pachymetry using ultrasound (CPT 76514) for specific clinical indications and maintains existing billing requirements and medical necessity guidelines.
Action Required
By 10/01/2025: Billing team must update billing system and claims processing rules to recognize ICD-10 codes H40.841, H40.842, and H40.843 as medically necessary diagnosis codes for CPT 76514 (corneal pachymetry). Update claim scrubbing logic to allow claims with these diagnosis codes to process without denial. Provider office must ensure clinical documentation links one of these three codes to pachymetry testing performed on or after 10/01/2025. Verify that claims system does not append Modifier 50 when billing CPT 76514, and confirm that Modifiers 26 and TC are available if billing professional or technical components separately. Failure to update system rules may result in unnecessary claim denials for otherwise covered services.