Billing code 76513: Eye ultrasoundMedicare rate & RVUs in Oregon
Reports diagnostic ultrasound of the eye’s anterior segment, often used to assess structures such as the iris, angle, or ciliary body.
Medicare pays $76.07–$82.86 for 76513 in the office in Oregon, from Rest Of Oregon to Portland. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 76513 covers
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.
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.
Where 76513 pays more and less in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland | $82.86 | Unavailable |
| Rest Of Oregon | $76.07 | Unavailable |
How the 76513 rate is calculated
Each of 76513’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 76513
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.59Practice expense 1.68Malpractice 0.02
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 76513
The CMS indicators that decide how 76513 is paid alongside other services.
CMS payment indicators · 76513
Eye ultrasound
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| Multiple procedures | 7 | Diagnostic ophthalmology reduction applies to the technical component. |
| Bilateral (modifier 50) | 3 | Each side paid at 100% (no 150% cap). |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 1 | Diagnostic test with separate professional (26) and technical (TC) components. |
What modifiers do to the payment
Modifier 26 · payment effect
With and without the modifier
76513 without 26 · national office
$76.49
Eye ultrasound
76513-26 · Professional component
$32.40
Pays only the interpretation and report.
76513 compared with similar codes
Compare codes
76513 vs 76512 vs 76510 vs 76514 vs 76516: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 76512Eye ultrasound
- Choose 76513 for anterior-segment imaging; choose 76512 for B-scan evaluation of the posterior segment.
- 76510Eye ultrasound
- 76510 combines B-scan and quantitative A-scan components. It is not the anterior-segment study reported with 76513.
- 76514Corneal pachymetry
- 76514 measures eye thickness, while 76513 images anterior-segment structures such as the angle or ciliary body.
- 76516Eye biometry
- 76516 is used for ocular biometry; 76513 evaluates the anterior segment rather than measuring the eye for biometry.
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 indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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