$45.41
Choose 76513 for anterior-segment imaging; choose 76512 for B-scan evaluation of the posterior segment.
On this page
CMS RVU26D · Effective 2026-10-01
76513 Eye ultrasound Medicare reimbursement rates in Kentucky
Reports diagnostic ultrasound of the eye’s anterior segment, often used to assess structures such as the iris, angle, or ciliary body. Compare 76513 office and facility rates across CMS payment localities in Kentucky.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 76513 in Kentucky?
Kentucky has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$70.20
1 of 1 localities have a supported rate.
Payment area: Kentucky
One mapped payment locality.
Facility setting
No supported rate
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Ophthalmology
About 76513: Anterior segment eye ultrasound
Reports diagnostic ultrasound of the eye’s anterior segment, often used to assess structures such as the iris, angle, or ciliary body.
This diagnostic study uses ultrasound to image the front portion of the eye, including structures that may be difficult to assess through the cornea or with routine examination. It is commonly performed in ophthalmology practices by trained imaging staff, with the ophthalmologist interpreting the images and documenting the findings. Ultrasound biomicroscopy is a familiar application when detailed anterior-segment imaging is needed, such as evaluating the angle or ciliary body.
Report the service when the study and interpretation address the anterior segment, rather than posterior-segment imaging, corneal thickness, or ocular biometry. Documentation should identify the clinical reason, eye examined, imaging findings, and interpretation. The code may be billed globally or as a professional component with modifier 26 or a technical component with modifier TC. For bilateral studies, CMS pays each side separately at 100%. When multiple ophthalmology diagnostic procedures are performed, the multiple-procedure reduction applies to the technical component.
CMS billing rules for 76513
- Professional and technical components
- Diagnostic test with a professional component (modifier 26, interpretation) and a technical component (modifier TC, equipment and staff); billing without a modifier is the global service.
- Multiple procedures
- Ophthalmology diagnostic multiple procedure reduction applies to the technical component.
- Bilateral procedures
- Each side is paid separately at 100% when performed bilaterally.
Where the value comes from
- Work RVU0.59 · 26%
- Practice expense (office) RVU1.68 · 73%
- Malpractice RVU0.02 · 1%
11K
Medicare services in 2024 · #1429 by national volume
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
76513 compared with similar codes
Office rates for Kentucky, from the same CMS release.
$63.71
76510 combines B-scan and quantitative A-scan components. It is not the anterior-segment study reported with 76513.
$10.93
76514 measures eye thickness, while 76513 images anterior-segment structures such as the angle or ciliary body.
$43.92
76516 is used for ocular biometry; 76513 evaluates the anterior segment rather than measuring the eye for biometry.
Compare 76513 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Kentucky →
Office / nonfacility
$70.20
Facility
Unavailable
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 76513 in Kentucky.
PPRRVU2026_Oct_nonQPP.csv
8,715
- Code
- 76513
- Physician work
- 0.59
- Practice expense
- 1.68
- Malpractice
- 0.02
GPCI2026.csv
55
- Locality
- Kentucky
- Physician work
- 1.000
- Practice expense
- 0.889
- Malpractice
- 0.915
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.59 | × 1.000 | 0.5900 |
| Practice expense | 1.68 | × 0.889 | 1.4935 |
| Malpractice | 0.02 | × 0.915 | 0.0183 |
| Total RVUs | 2.1018 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Kentucky$70.20
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.59 | 1 |
| Practice expense | 1.68 | 0.889 |
| Malpractice | 0.02 | 0.915 |
(0.59 × 1 + 1.68 × 0.889 + 0.02 × 0.915) × $33.4009 = $70.20
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
76513 billing questions
When should this code be chosen instead of 76512?
Use 76513 for diagnostic ultrasound imaging of the anterior segment. Code 76512 describes B-scan imaging used to evaluate the eye’s posterior segment.
Can the professional and technical portions be billed separately?
Yes. Modifier 26 identifies the interpretation, and modifier TC identifies the equipment and staff portion. Without either modifier, the claim represents the global service.
How is a bilateral study handled?
Document which eye or eyes were examined. CMS pays each side separately at 100% when the study is performed bilaterally.
Does the multiple-procedure reduction affect both components?
The ophthalmology diagnostic multiple-procedure reduction applies to the technical component of this service.
What documentation supports reporting 76513?
Record the clinical indication, laterality, anterior-segment images or findings, and the interpreting physician’s report. The record should support that the study evaluated the anterior segment.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
8,71276512,,Oph us dx b-scan,A,,0.55,0.89,,0.89,NA,0.02,1.46,1.46,1,XXX,0.00,0.00,0.00,7,3,0,0,0,9,,33.4009,09,0,99,3.49,3.49,0.07
8,71376512,26,Oph us dx b-scan,A,,0.55,0.35,,0.35,,0.01,0.91,0.91,1,XXX,0.00,0.00,0.00,7,3,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
8,71476512,TC,Oph us dx b-scan,A,,0.00,0.54,,0.54,NA,0.01,0.55,0.55,1,XXX,0.00,0.00,0.00,7,3,0,0,0,9,,33.4009,02,0,99,3.14,3.14,0.06
8,71576513,,Oph us dx ant sgm us uni/bi,A,,0.59,1.68,,1.68,NA,0.02,2.29,2.29,1,XXX,0.00,0.00,0.00,7,3,0,0,0,9,,33.4009,09,0,99,3.54,3.54,0.03
8,71676513,26,Oph us dx ant sgm us uni/bi,A,,0.59,0.37,,0.37,,0.01,0.97,0.97,1,XXX,0.00,0.00,0.00,7,3,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
8,71776513,TC,Oph us dx ant sgm us uni/bi,A,,0.00,1.31,,1.31,NA,0.01,1.32,1.32,1,XXX,0.00,0.00,0.00,7,3,0,0,0,9,,33.4009,02,0,99,3.17,3.17,0.02
8,71876514,,Echo exam of eye thickness,A,,0.14,0.19,,0.19,NA,0.02,0.35,0.35,1,XXX,0.00,0.00,0.00,7,2,0,0,0,9,,33.4009,09,0,99,0.89,0.89,0.08
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915
5607202,LA,01,NEW ORLEANS,1.000,0.941,1.136
5707202,LA,99,REST OF LOUISIANA,1.000,0.885,0.958
5814112,ME,03,SOUTHERN MAINE,1.000,0.991,0.631