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LCD L33630: Corneal Pachymetry

LCD L33630, Corneal Pachymetry, is the Local Coverage Determination that Wellpoint Federal applies to claims from 13 states (CT, DN, IL, MA, ME, MN, NH, NY and others), effective 2026-04-01 and first in force 2015-10-01. The policy text runs 289 words, and its billing and coding article A56548 lists 262 ICD-10-CM codes that support medical necessity for 2 procedure codes. 2 other contractors publish a policy with the same title, so the criteria that apply depend on where the service is furnished.

QuickIntell editorial content · Legacy registry date · Review not verified

Data effective
Data currency: Medicare Coverage Database LCD export release of September 24, 2026 (effective September 20, 2026). Next CMS release: weekly (Thursdays) for the MCD.
Contractor
Wellpoint Federal
States and territories
13
CT DN IL MA ME MN NH NY QN RI UN VT WI
Revision effective
2026-04-01
Original effective
2015-10-01
Policy text
289 words
Covered ICD-10 codes (articles)
262

Where this LCD applies

Each contract number is a jurisdiction on the remittance; the policy binds claims processed under these contracts and no others.

Contracts that apply LCD L33630
ContractContractorTypeStates
06101Wellpoint FederalMAC - Part AIL
06201Wellpoint FederalMAC - Part AMN
06301Wellpoint FederalMAC - Part AWI
06102Wellpoint FederalMAC - Part BIL
06202Wellpoint FederalMAC - Part BMN
06302Wellpoint FederalMAC - Part BWI
13101Wellpoint FederalA and B and HHH MACCT
13201Wellpoint FederalA and B and HHH MACNY
13102Wellpoint FederalA and B and HHH MACCT
13202Wellpoint FederalA and B and HHH MACDN
13282Wellpoint FederalA and B and HHH MACUN
13292Wellpoint FederalA and B and HHH MACQN
14411Wellpoint FederalA and B and HHH MACRI
14211Wellpoint FederalA and B and HHH MACMA
14311Wellpoint FederalA and B and HHH MACNH
14511Wellpoint FederalA and B and HHH MACVT
14111Wellpoint FederalA and B and HHH MACME
14112Wellpoint FederalA and B and HHH MACME
14212Wellpoint FederalA and B and HHH MACMA
14312Wellpoint FederalA and B and HHH MACNH
14512Wellpoint FederalA and B and HHH MACVT
14412Wellpoint FederalA and B and HHH MACRI

Billing and coding: diagnoses and procedure codes

Since 2019 the codes live in the companion article rather than the LCD. Billing and Coding A56548 (Billing and Coding: Corneal Pachymetry) carries the diagnosis and procedure lists the contractor loads as the claims edit. CPT codes are shown as bare numbers because the descriptors are licensed by the AMA; HCPCS Level II descriptors are public and shown.

A56548: Billing and Coding: Corneal Pachymetry (Billing and Coding, effective 2026-04-01)

Covered ICD-10-CM codes
262
1 group
Non-covered ICD-10-CM codes
0
Procedure codes listed
2
Full article
cms.gov record
First 24 covered ICD-10-CM codes in A56548
ICD-10-CMDescription (FY2027)
H18.11—
H18.12—
H18.13—
H18.221—
H18.222—
H18.223—
H18.231—
H18.232—
H18.233—
H18.461—
H18.462—
H18.463—
H18.501—
H18.502—
H18.503—
H18.511—
H18.512—
H18.513—
H18.521—
H18.522—
H18.523—
H18.531—
H18.532—
H18.533—

Procedure codes: 76514, 92499.

Coverage indications, limitations and medical necessity

Abstract:

Corneal Pachymetry is the measurement of corneal thickness and commonly uses either ultrasonic or optical methods. Measurement of corneal thickness in individuals presenting with increased intraocular pressure assists in determining if there is a risk of glaucoma or if the individual's increased eye pressure is the result of abnormal corneal thickness. The test must be integral to the medical management decision-making of the patient. Coverage is limited to ophthalmologists and optometrists.

Indications and Limitations:

Medicare will consider corneal pachymetry to be medically necessary and reasonable when performed to determine the amount of endothelial trauma sustained during surgery, assessment of the health of the cornea pre-operatively in Fuch's dystrophy, post ocular trauma and for the assessment of corneal thickness or (in suspected glaucoma) following the diagnosis of increased intraocular pressure prior to the initiation of a treatment regimen for glaucoma. It is expected that services for the measurement of corneal thickness following the diagnosis of increased intraocular pressure will be performed once in a lifetime, unless there has been interval corneal trauma or surgery.

Medicare will consider corneal pachymetry to be medically necessary and reasonable when performed only by ophthalmologist and optometrists.

Medicare will not pay for use of pachymetry when used in preparation for surgery to reshape the cornea of the eye for the purpose of correcting visual problems (refractive surgery), such as myopia (nearsightedness) and hyperopia (farsightedness).

Whether patients have been previously diagnosed and are under treatment for glaucoma or are newly diagnosed, pachymetry will be covered once per lifetime, or more frequently in cases where there has been surgical or non-surgical trauma.

When there is a question of corneal disease supported by diagnosis, then pachymetry may be performed at the same time as endothelial cell count.

Summary of evidence (opening)

N/A

the full summary and analysis of evidence are in the CMS record.

Dates, lineage and related policies

Original determination effective
2015-10-01
Current revision effective
2026-04-01
Last reviewed by the contractor
2017-06-01
MCD version
28
Derived from
L28142

Using this policy on a claim

Match the documented indication to the covered indications above before the service is scheduled, carry a diagnosis from the article's covered list on the claim line, and keep the elements the documentation section asks for in the record, because the contractor can request it later through medical review. A denial under this policy arrives as CARC 50 with remark N115; the LCD lookup guide walks through the appeal path and the Advance Beneficiary Notice rules, and the Wellpoint Federal hub lists every other active policy from the same contractor.

The same policy title at other contractors

Contractors often adopt each other's policies and then revise them separately, so the criteria and the diagnosis lists drift apart. The topic comparison lines up every version.

L33999
CGS Administrators, LLC · 2 states · revised 2026-01-22 · 217 covered codes
L34512
Palmetto GBA · 7 states · revised 2022-06-09 · 214 covered codes

Frequently asked questions

What does LCD L33630 cover?

Corneal Pachymetry is the measurement of corneal thickness and commonly uses either ultrasonic or optical methods. Measurement of corneal thickness in individuals presenting with increased intraocular pressure assists in determining if there is a risk of glaucoma or if the individual's increased eye pressure is the result of abnormal corneal thickness. The test must be integral to the medical management… The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database export of September 24, 2026.

Which states does LCD L33630 apply to?

Wellpoint Federal applies it to Medicare claims in CT, DN, IL, MA, ME, MN, NH, NY, QN, RI, UN, VT, WI. A Local Coverage Determination binds only the contractor that wrote it; the same service in another jurisdiction is judged under that contractor's own policy or, where none exists, claim by claim.

Which diagnosis codes support medical necessity under LCD L33630?

The companion billing and coding article A56548 lists 262 ICD-10-CM codes in 1 group that support medical necessity; the first 24 appear on this page and the complete list is in the article on cms.gov.

How do I appeal a denial under LCD L33630?

The remittance carries claim adjustment reason code 50 with remark code N115, naming the LCD. Compare the documented indication with the policy's covered indications and the article's diagnosis list, then file a redetermination within 120 days with the record attached; if the service genuinely falls outside the policy, the patient can be billed only when a valid Advance Beneficiary Notice was obtained before the service.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-02. Verify against the primary file before billing or contracting decisions.

Disclaimer

The policy text and code lists are reproduced from the CMS Medicare Coverage Database export as an operational reference. Verify against the current LCD and article on cms.gov before billing; coverage depends on the full record and the contractor. Not legal, clinical or billing advice.