Medicare to reimburse for Argus II retinal prosthesis

The Centers for Medicare and Medicaid Services (CMS) has approved the Argus II Retinal Prosthesis System as a new technology, providing payment in both inpatient and outpatient settings.

Beginning Oct. 1, 2013, cases involving the Argus II System that are eligible for new technology add-on payments under the Medicare Inpatient Prospective Payment System will be identified by a new ICD-9-CM procedure code 14.81. Additionally, CMS has also established a transitional pass through payment for Argus II. This payment will be available to all hospital outpatient facilities and Ambulatory Surgical Centers that perform this procedure for Medicare beneficiaries, and will be identified by the 0100T CPT code.

Originally approved in the U.S. as a humanitarian use device, the Argus II (Second Sight Medical Products) is intended for patients 25 years or older who have severe to profound retinitis pigmentosa, bare or no light perception, evidence of intact inner layer retina function, and a history of being able to see forms.

The system includes an external video camera, video processing unit and transmitter mounted on a pair of eyeglasses, along with electrodes implanted internally onto the patient's retina. The video processor wirelessly transmits images captured from the camera as a series of electrical pulses to the electrodes, stimulating retinal cells to produce images.

While vision is not restored, patients can learn to interpret the pulses to regain some visual function, such as detecting light and dark or seeing movement.