**Abstract:**  
  
Corneal Pachymetry is the measurement of corneal thickness and commonly uses
either ultrasonic or optical methods. Measurement of corneal thickness in
individuals presenting with increased intraocular pressure assists in
determining if there is a risk of glaucoma or if the individual's increased
eye pressure is the result of abnormal corneal thickness. The test must be
integral to the medical management decision-making of the patient. Coverage is
limited to ophthalmologists and optometrists.  
  
**Indications and Limitations:**  
  
Medicare will consider corneal pachymetry to be medically necessary and
reasonable when performed to determine the amount of endothelial trauma
sustained during surgery, assessment of the health of the cornea pre-
operatively in Fuch's dystrophy, post ocular trauma and for the assessment of
corneal thickness or (in suspected glaucoma) following the diagnosis of
increased intraocular pressure prior to the initiation of a treatment regimen
for glaucoma. It is expected that services for the measurement of corneal
thickness following the diagnosis of increased intraocular pressure will be
performed once in a lifetime, unless there has been interval corneal trauma or
surgery.  
  
Medicare will consider corneal pachymetry to be medically necessary and
reasonable when performed only by ophthalmologist and optometrists.  
  
Medicare will not pay for use of pachymetry when used in preparation for
surgery to reshape the cornea of the eye for the purpose of correcting visual
problems (refractive surgery), such as myopia (nearsightedness) and hyperopia
(farsightedness).  
  
Whether patients have been previously diagnosed and are under treatment for
glaucoma or are newly diagnosed, pachymetry will be covered once per lifetime,
or more frequently in cases where there has been surgical or non-surgical
trauma.  
  
When there is a question of corneal disease supported by diagnosis, then
pachymetry may be performed at the same time as endothelial cell count.  
  
 **Other Comments:**  
For claims submitted to the Part A MAC: This coverage determination also
applies within states outside the primary geographic jurisdiction with
facilities that have nominated CGS Administrators, LLC. to process their
claims.  
  
Bill type codes only apply to providers who bill these services to the Part A
MAC. Bill type codes do not apply to physicians, other professionals and
suppliers who bill these services to the carrier or Part B MAC.  
  
Limitation of liability and refund requirements apply when denials are likely,
whether based on medical necessity or other coverage reasons. The
provider/supplier must notify the beneficiary in writing, prior to rendering
the service, if the provider/supplier is aware that the test, item or
procedure may not be covered by Medicare. The limitation of liability and
refund requirements do not apply when the test, item or procedure is
statutorily excluded, has no Medicare benefit category or is rendered for
screening purposes.  
  
For outpatient settings other than CORFs, references to "physicians"
throughout this policy include non-physicians, such as nurse practitioners,
clinical nurse specialists and physician assistants. Such non-physician
practitioners, with certain exceptions, may certify, order and establish the
plan of care for as authorized by State law. (See Sections 1861[s][2] and
1862[a][14] of Title XVIII of the Social Security Act; 42 CFR, Sections
410.74, 410.75, 410.76 and 419.22; 58 FR 18543, April 7, 2000.)  
  
For dates of service on or after April 1, 2010, bill type 77X should be used
to report FQHC services.