**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 involving the
cornea  
  
 Preoperative assessment of the health of the cornea in Fuch's dystrophy  
  
 Assessment of corneal thickness after ocular trauma  
  
 Assessment of corneal thickness in suspected glaucoma following the
diagnosis of increased intraocular pressure AND prior to the initiation of a
treatment regimen for glaucoma  
  
It is expected that a service for a corneal thickness measurement following
the diagnosis of increased intraocular pressure will be performed once in a
lifetime per beneficiary, unless there has been interval corneal trauma or
surgery following a previous measurement. The lifetime limit ONLY applies for
measurements done to assess corneal thickness, in conjunction with a glaucoma
diagnosis. The limit does not apply in cases where the assessment of corneal
thickness is required after ocular trauma (surgical or accidental) has been
sustained, including the management of bullous keratopathy resulting from
surgical or accidental trauma, or in Fuch's dystrophy.  
  
Medicare will consider corneal pachymetry to be medically necessary and
reasonable when performed only by ophthalmologists 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). When the change in the corneal shape results from a previous
partial or complete corneal transplant, Medicare will cover a pachymetry
service.  
  
Whether patients have been previously diagnosed and are under treatment for
glaucoma or are newly diagnosed, pachymetry will be covered once per lifetime
per beneficiary, or more frequently in cases where there has been surgical or
non-surgical trauma.  
  
**Other Comments:**  
  
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 Comprehensive Outpatient Rehabilitation
Facilities (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 as authorized by
State law.