Local Coverage Article Billing and Coding

Billing and Coding: Computerized Corneal Topography


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Article ID
Article Title
Billing and Coding: Computerized Corneal Topography
Article Type
Billing and Coding
Original Effective Date
Revision Effective Date
Revision Ending Date
Retirement Date
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Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

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CMS National Coverage Policy


Article Guidance

Article Text

This article gives guidance for billing, coding, and other guidelines in relation to local coverage policy L34008 Computerized Corneal Topography .


General Guidelines for Claims submitted to Part A or Part B MAC:

Procedure codes may be subject to National Correct Coding Initiative (NCCI) edits or OPPS packaging edits. Refer to NCCI and OPPS requirements prior to billing Medicare. For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim. A claim submitted without a valid ICD-10-CM diagnosis code will be returned to the provider as an incomplete claim under Section 1833(e) of the Social Security Act. The diagnosis code(s) must best describe the patient's condition for which the service was performed. For diagnostic tests, report the result of the test if known; otherwise the symptoms prompting the performance of the test should be reported.


Advance Beneficiary Notice of Non-coverage (ABN) Modifier Guidelines

An ABN may be used for services which are likely to be non-covered, whether for medical necessity or for other reasons. Refer to CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 30, for complete instructions.

Effective from April 1, 2010, non-covered services should be billed with modifier –GA, -GX, -GY, or –GZ, as appropriate.

The –GA modifier (“Waiver of Liability Statement Issued as Required by Payer Policy”) should be used when physicians, practitioners, or suppliers want to indicate that they anticipate that Medicare will deny a specific service as not reasonable and necessary and they do have an ABN signed by the beneficiary on file. Modifier GA applies only when services will be denied under reasonable and necessary provisions, sections 1862(a)(1), 1862(a)(9), 1879(e), or 1879(g) of the Social Security Act. Effective April 1, 2010, Part A MAC systems will automatically deny services billed with modifier GA. An ABN, Form CMS-R-131, should be signed by the beneficiary to indicate that ‎he/she accepts responsibility for payment.‎ The -GA modifier may also be used on assigned claims when a patient refuses to sign the ABN and the latter is properly witnessed. For claims submitted to the Part A MAC, occurrence code 32 and the date of the ABN is required.


Modifier GX (“Notice of Liability Issued, Voluntary Under Payer Policy”) should be used when the beneficiary has signed an ABN, and a denial is anticipated based on provisions other than medical necessity, such as statutory exclusions of coverage or technical issues. An ABN is not required for these denials, but if non-covered services are reported with modifier GX, will automatically be denied services.


The –GZ modifier should be used when physicians, practitioners, or suppliers want to indicate that they expect that Medicare will deny an item or service as not reasonable and necessary and they have not had an ABN signed by the beneficiary. ‎If the service is statutorily non-covered, or without a benefit category, submit the ‎appropriate CPT/HCPCS code with the -GY modifier. An ABN is not required for these denials, and the limitation of liability does not apply for beneficiaries. Services with modifier GY will automatically deny.

Documentation Requirements

The patient’s medical record should include but is not limited to:

  • The assessment of the patient by the ordering provider as it relates to the complaint of the patient for that visit,
  • Relevant medical history
  • Results of pertinent tests/procedures
  • Signed and dated office visit record/operative report (Please note that all services ordered or rendered to Medicare beneficiaries must be signed.)

Coding Information


Group 1

(1 Code)
Group 1 Paragraph


Group 1 Codes

CPT/HCPCS Modifiers


ICD-10-CM Codes that Support Medical Necessity

Group 1

(77 Codes)
Group 1 Paragraph

ICD-10 codes Z96.1, Z98.41, and Z98.42 must be accompanied by ICD-10 code H52.211, H52.212, or H52.213.

Group 1 Codes
H11.001 - H11.003 Unspecified pterygium of right eye - Unspecified pterygium of eye, bilateral
H11.011 - H11.013 Amyloid pterygium of right eye - Amyloid pterygium of eye, bilateral
H11.021 - H11.023 Central pterygium of right eye - Central pterygium of eye, bilateral
H11.031 - H11.033 Double pterygium of right eye - Double pterygium of eye, bilateral
H11.041 - H11.043 Peripheral pterygium, stationary, right eye - Peripheral pterygium, stationary, bilateral
H11.051 - H11.053 Peripheral pterygium, progressive, right eye - Peripheral pterygium, progressive, bilateral
H11.061 - H11.063 Recurrent pterygium of right eye - Recurrent pterygium of eye, bilateral
H16.051 - H16.053 Mooren's corneal ulcer, right eye - Mooren's corneal ulcer, bilateral
H16.301 - H16.303 Unspecified interstitial keratitis, right eye - Unspecified interstitial keratitis, bilateral
H16.321 - H16.323 Diffuse interstitial keratitis, right eye - Diffuse interstitial keratitis, bilateral
H16.331 - H16.333 Sclerosing keratitis, right eye - Sclerosing keratitis, bilateral
H17.9 Unspecified corneal scar and opacity
H18.11 - H18.13 Bullous keratopathy, right eye - Bullous keratopathy, bilateral
H18.421 - H18.423 Band keratopathy, right eye - Band keratopathy, bilateral
H18.451 - H18.453 Nodular corneal degeneration, right eye - Nodular corneal degeneration, bilateral
H18.591 Other hereditary corneal dystrophies, right eye
H18.592 Other hereditary corneal dystrophies, left eye
H18.593 Other hereditary corneal dystrophies, bilateral
H18.601 - H18.603 Keratoconus, unspecified, right eye - Keratoconus, unspecified, bilateral
H18.611 - H18.613 Keratoconus, stable, right eye - Keratoconus, stable, bilateral
H18.621 - H18.623 Keratoconus, unstable, right eye - Keratoconus, unstable, bilateral
H18.711 - H18.713 Corneal ectasia, right eye - Corneal ectasia, bilateral
H52.211 - H52.213 Irregular astigmatism, right eye - Irregular astigmatism, bilateral
H53.2 Diplopia
T85.21XA Breakdown (mechanical) of intraocular lens, initial encounter
T85.22XA Displacement of intraocular lens, initial encounter
T85.318A Breakdown (mechanical) of other ocular prosthetic devices, implants and grafts, initial encounter
T85.328A Displacement of other ocular prosthetic devices, implants and grafts, initial encounter
T86.8401 Corneal transplant rejection, right eye
T86.8402 Corneal transplant rejection, left eye
T86.8403 Corneal transplant rejection, bilateral
T86.8411 Corneal transplant failure, right eye
T86.8412 Corneal transplant failure, left eye
T86.8413 Corneal transplant failure, bilateral
Z94.7 Corneal transplant status
Z96.1 Presence of intraocular lens
Z98.41 Cataract extraction status, right eye
Z98.42 Cataract extraction status, left eye
Z98.83 Filtering (vitreous) bleb after glaucoma surgery status

ICD-10-CM Codes that DO NOT Support Medical Necessity


ICD-10-PCS Codes


Additional ICD-10 Information


Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

011x Hospital Inpatient (Including Medicare Part A)
012x Hospital Inpatient (Medicare Part B only)
013x Hospital Outpatient
071x Clinic - Rural Health
073x Clinic - Freestanding
077x Clinic - Federally Qualified Health Center (FQHC)
085x Critical Access Hospital

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Revenue codes only apply to providers who bill these services to the Part A MAC. Revenue codes do not apply to physicians, other professionals and suppliers who bill these services to the carrier or Part B MAC.

Please note that not all revenue codes apply to every type of bill code. Providers are encouraged to refer to the FISS revenue code file for allowable bill types. Similarly, not all revenue codes apply to each CPT/HCPCS code. Providers are encouraged to refer to the FISS HCPCS file for allowable revenue codes.

All revenue codes billed on the inpatient claim for the dates of service in question may be subject to review.

0360 Operating Room Services - General Classification
0409 Other Imaging Services - Other Imaging Services
0450 Emergency Room - General Classification
0510 Clinic - General Classification
0519 Clinic - Other Clinic
0520 Freestanding Clinic - General Classification
0521 Freestanding Clinic - Clinic Visit by Member to RHC/FQHC
0523 Freestanding Clinic - Family Practice Clinic
0529 Freestanding Clinic - Other Freestanding Clinic
0761 Specialty Services - Treatment Room
0920 Other Diagnostic Services - General Classification
0929 Other Diagnostic Services - Other Diagnostic Service
0960 Professional Fees - General Classification
0962 Professional Fees - Ophthalmology

Other Coding Information


Revision History Information

Revision History DateRevision History NumberRevision History Explanation
01/26/2023 R6


Revision Effective: 01/26/2023

Revision Explanation: Annual Review, no changes were made.

02/03/2022 R5


Revision Effective: 02/03/2022

Revision Explanation: Annual Review, no changes were made

02/04/2021 R4


Revision Effective: 02/04/2021

Revision Explanation: Annual Review, no changes were made

10/01/2020 R3

Revision Effective:10/01/2020
Revision Explanation: During the annual ICD-10 update codes H18.59, T86.840, and T86.841 were deleted and replaced with codes: H18.591-H18.593, T86.8401-T86.8403, and T86.8411-T86.8413.

09/19/2019 R2

Revision Effective: N/A

Revision Explanation: Annual Review, no changes

09/19/2019 R1


Revision Effective: 09/19/2019

Revision Explanation: Converted article into new Billing and Coding template no other changes made.

Associated Documents

Related Local Coverage Documents
L34008 - Computerized Corneal Topography
Related National Coverage Documents
Statutory Requirements URLs
Rules and Regulations URLs
CMS Manual Explanations URLs
Other URLs
Public Versions
Updated On Effective Dates Status
01/20/2023 01/26/2023 - N/A Currently in Effect You are here
01/25/2022 02/03/2022 - 01/25/2023 Superseded View
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