Reimbursement for Tests with the OCULUS Pentacam

Topic: OCULUS Pentacam

Sponsor: OCULUS

Updated: 03/11/2021

OCULUS

OCULUS’ Pentacam® and Pentacam AXL® are multipurpose diagnostic instruments for evaluating the anterior segment using tomography. Tomography provides a three dimensional digital picture of the anterior segment from a variety of vantage points. The Pentacam AXL adds another functionality: optical coherence biometry (OCB) for measurement of axial length of the eye.

This monograph describes reimbursement for tests performed with the Pentacam and Pentacam AXL, either alone or as part of another service. They include:

  • Optical tomography of the anterior segment (SCODI-A)
  • Anterior segment photography
  • Corneal topography
  • Corneal pachymetry
  • Optical coherence biometry and intraocular lens (IOL) calculation, including optimization of IOL constants over time (AXL only)
  • Planning for phakic IOL
  • Lens densitometry
  • Zernike and wavefront analysis of the cornea
  • Contact lens fitting

These tests are useful in evaluation and management of disease, planning for anterior segment surgery, and contact lens fitting.

Much of the information is taken from official publications of the Medicare program, including the Centers for Medicare and Medicaid (CMS) and the Medicare Administrative Contractors (MAC). However, the reader is encouraged to check with the local MAC for additional information and instructions. 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-10-CM and ICD-9-CM. Documentation of the medical necessity of the procedure is always a prerequisite to reimbursement, so we describe the required elements in detail.