Reimbursement for Tests with the OCULUS Keratograph 5M

Topic: OCULUS Keratograph 5M

Sponsor: OCULUS

Updated: 03/11/2021


This monograph describes reimbursement for tests performed with the OCULUS Keratograph® 5M, either alone or as part of another service. The Keratograph 5M is a multipurpose diagnostic instrument for evaluating the anterior segment using topography, photography, and other imaging. The instrument can perform multiple tests, depending on the patient’s and provider’s needs. These tests and features include: Corneal topography

  • Keratometry
  • Anterior segment photography
  • Zernike and Fourier analysis of the cornea
  • Contact lens fitting
  • Tear meniscus height
  • Lipid layer thickness
  • Meibomian gland imaging
  • Tear film break-up time
  • Pupillometry
  • Oxi-Map

These tests supplement the ophthalmologist’s or optometrist’s evaluation and management of corneal and lacrimal disease, planning for anterior segment surgery, and contact lens fitting. Some features of the Keratograph 5M are particularly useful for patient education.

Much of the information is taken from official publications of the Medicare program, including the Centers for Medicare & Medicaid (CMS) and the Medicare Administrative Contractors (MAC). However, the reader is encouraged to check with the local MAC for additional information and instructions as not all guidelines are the same. In the case of other third party payers, we have used the coding concepts contained in CPT and published by the American Medical Association; diagnosis codes are from ICD-9-CM and ICD-10-CM. Documentation of the medical necessity of any diagnostic test is a pre-requisite to reimbursement, so we describe the required elements in detail.

Since economic analyses are a necessary part of any capital budgeting decision, we incorporated Medicare’s payment rates for the procedures as well as utilization rates.