• How to Bill for MIGS


    Use of micro-invasive glaucoma surgeries continues to grow, as EyeNet explored in a recent cover story. However, none of the three main devices used in MIGS yet has a level 1 CPT code or established relative value units. To help you ensure you bill appropriately for both implantation and any complications that arise, the Academy has developed guidance, including printable fact sheets, to help you code correctly the first time.

    General principles

    Codes and coverage

    iStent, iStent inject and Hydrus

    Download the iStent iStent inject and Hydrus coding fact sheet [PDF]. Updated Oct. 2018.

    • Category III codes:
      • 0191T Insertion of anterior segment aqueous drainage device, without extraocular reservoir; internal approach, into the trabecular meshwork; initial insertion
      • +0376T Insertion of anterior segment aqueous drainage device, without extraocular reservoir; internal approach into the trabecular meshwork; each additional device insertion (list separately in addition to code for primary procedure)
    • Coverage:
      • Medicare Part B and Medicare Advantage plans cover it when performed in conjunction with cataract surgery.
      • Commercial coverage varies. When preauthorizing, always ask for the allowed amount. Having an assigned fee almost always guarantees payment. Otherwise, best to alert the patient that they may be responsible for payment.
      • If inserted sometime after cataract surgery, the patient is responsible for all charges. No need for an ABN for the Medicare Part B patient as payment is statutorily excluded.

    CyPass

    Alcon has issued a voluntary global recall of the CyPass microstent, effective immediately.

    Download the CyPass coding fact sheet [PDF]. Updated Oct. 16, 2018.

    XEN Gel Stents

    Download the XEN Gel Stent coding fact sheet [PDF]. Updated Nov. 16, 2018.

    • Category III codes:
      • 0449T Insertion of anterior segment aqueous drainage device, without extraocular reservoir, internal approach into the subconjunctival space; initial device (new in January 2017)
      • +0450T each additional device (list separately in addition to code for primary procedure)
    • Coverage:
      • FDA approved when inserted with or without cataract surgery.
      • Medicare Part B coverage: Visit aao.org/lcds or your Medicare Administrative Contractor website for guidance.
      • Commercial coverage varies. When preauthorizing, always ask for the allowed amount. Having an assigned fee almost always guarantees payment. Otherwise, best to alert the patient that they may be responsible for payment.

    How to code normal insertion

    • Submit 66984 -eye modifier or 66982 -eye modifier, if case meets indications for complex cataract surgery and
    • Submit the appropriate eye modifier:
      • iStent 0191T -eye modifier
      • CyPass 0474T -eye modifier
      • XEN Gel: This is not a requirement for XEN as it can be performed without cataract surgery.
    • No need to append modifier -51 indicating multiple procedures performed during the same operative period.
    • How to code special cases:
      • Repositioning: report CPT code 66999.
      • Removing a device: Report CPT code 65920 Removal of implanted material, anterior segment of eye. If removed within the global period of the cataract surgery, append modifier -78 Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the global period. Do not start a new global period. Continue the 90-days postop from the cataract surgery. Payment will be 80 percent of the allowable.
      • When inserting more than one device at the same time as the initial device:
        • iStent: Report +0376T. Do not append modifier -51 to add-on codes.
        • XEN Gel: Report +0450T. Do not append modifier -51 to add-on codes.