LCD Reference Article Billing and Coding Article

Billing and Coding: Micro-Invasive Glaucoma Surgery (MIGS)

A56491

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Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.

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Note History

Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A56491
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Micro-Invasive Glaucoma Surgery (MIGS)
Article Type
Billing and Coding
Original Effective Date
09/26/2019
Revision Effective Date
07/06/2023
Revision Ending Date
N/A
Retirement Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

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Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

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CMS National Coverage Policy

N/A

Article Guidance

Article Text

This article gives guidance for billing, coding, and other guidelines in relation to local coverage policy for L37578-Micro-Invasive Glaucoma Surgery (MIGS).

 

The Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS) code(s) may be subject to National Correct Coding Initiative (NCCI) edits. This information does not take precedence over NCCI edits. Please refer to NCCI for correct coding guidelines and specific applicable code combinations prior to billing Medicare.

Coding Guidance

For noncomplex cataract removal with insertion of aqueous drainage system, use CPT 66991.

For complex cataract removal with intraocular lens implant and concomitant intraocular aqueous drainage device, use CPT code 66989.

Please refer to the "Limitations" section in the related LCD for additional information.

For Part A claims:

  • Line SV202-7 for 837I electronic claim
  • Block 80 for the UB04 claim form

For Part B claims:

  • Loop 2400 or SV101-7 for the 5010A1 837P
  • Box 19 for paper claim

Frequency Limitations

Medicare may cover only 1 unit per eye, per date of service of CPT code 66991 and 66989 for insertion of glaucoma drainage device(s) into the trabecular meshwork (e.g., iStent®, or iStent inject®), when performed in conjunction with cataract surgery and when the medically reasonable and necessary criteria as stated in the LCD are met. Although more than one drainage device into the trabecular meshwork of a single eye on a single day of service, using an insertion tool loaded with more than one device, (e.g., iStent inject®), may be performed, once the insertion tool is deployed within the eye, there is negligible increase in work or expense. Therefore only one unit of 66991 and 66989 per eye, per day may be billed, regardless of the number of devices inserted into a single eye on the date of service.

Medicare may cover only 1 unit per eye, per date of service of CPT code 0449T for insertion of glaucoma drainage device(s) into the subconjunctival space (e.g., XEN45®), when the medically reasonable and necessary criteria as stated in the LCD are met.

Documentation Requirements

  1. All documentation must be maintained in the patient's medical record and must support the medical necessity of the services as directed in this article and be made available to the contractor upon request.

  2. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.

  3. The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.

 

Response To Comments

Number Comment Response
1
N/A

Coding Information

Bill Type Codes

Code Description
013x Hospital Outpatient
083x Ambulatory Surgery Center
085x Critical Access Hospital
N/A

Revenue Codes

Code Description
036X Operating Room Services - General Classification
045X Emergency Room - General Classification
049X Ambulatory Surgical Care - General Classification
076X Specialty Services - General Classification
N/A

CPT/HCPCS Codes

Group 1

(2 Codes)
Group 1 Paragraph

Note: Providers are reminded to refer to the long descriptors of the CPT codes in their CPT book.

The CPT codes in Group 1 are considered medically necessary when the Indications of Coverage are met. The 90 day global periods applies.

Group 1 Codes
Code Description
66989 EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS (1-STAGE PROCEDURE), MANUAL OR MECHANICAL TECHNIQUE (EG, IRRIGATION AND ASPIRATION OR PHACOEMULSIFICATION), COMPLEX, REQUIRING DEVICES OR TECHNIQUES NOT GENERALLY USED IN ROUTINE CATARACT SURGERY (EG, IRIS EXPANSION DEVICE, SUTURE SUPPORT FOR INTRAOCULAR LENS, OR PRIMARY POSTERIOR CAPSULORRHEXIS) OR PERFORMED ON PATIENTS IN THE AMBLYOGENIC DEVELOPMENTAL STAGE; WITH INSERTION OF INTRAOCULAR (EG, TRABECULAR MESHWORK, SUPRACILIARY, SUPRACHOROIDAL) ANTERIOR SEGMENT AQUEOUS DRAINAGE DEVICE, WITHOUT EXTRAOCULAR RESERVOIR, INTERNAL APPROACH, ONE OR MORE
66991 EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS (1 STAGE PROCEDURE), MANUAL OR MECHANICAL TECHNIQUE (EG, IRRIGATION AND ASPIRATION OR PHACOEMULSIFICATION); WITH INSERTION OF INTRAOCULAR (EG, TRABECULAR MESHWORK, SUPRACILIARY, SUPRACHOROIDAL) ANTERIOR SEGMENT AQUEOUS DRAINAGE DEVICE, WITHOUT EXTRAOCULAR RESERVOIR, INTERNAL APPROACH, ONE OR MORE

Group 2

(1 Code)
Group 2 Paragraph

 The CPT codes in Group 2 are considered medically necessary when the Indications of Coverage are met. The 90 day global periods applies.

Group 2 Codes
Code Description
0449T INSERTION OF AQUEOUS DRAINAGE DEVICE, WITHOUT EXTRAOCULAR RESERVOIR, INTERNAL APPROACH, INTO THE SUBCONJUNCTIVAL SPACE; INITIAL DEVICE

Group 3

(3 Codes)
Group 3 Paragraph

The following CPT codes are considered not medically reasonable and necessary (non-covered).

Do not report 0671T in conjunction with 66989 or 66991

 

Group 3 Codes
Code Description
0253T INSERTION OF ANTERIOR SEGMENT AQUEOUS DRAINAGE DEVICE, WITHOUT EXTRAOCULAR RESERVOIR, INTERNAL APPROACH, INTO THE SUPRACHOROIDAL SPACE
0450T INSERTION OF AQUEOUS DRAINAGE DEVICE, WITHOUT EXTRAOCULAR RESERVOIR, INTERNAL APPROACH, INTO THE SUBCONJUNCTIVAL SPACE; EACH ADDITIONAL DEVICE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
0474T INSERTION OF ANTERIOR SEGMENT AQUEOUS DRAINAGE DEVICE, WITH CREATION OF INTRAOCULAR RESERVOIR, INTERNAL APPROACH, INTO THE SUPRACILIARY SPACE
N/A

CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(6 Codes)
Group 1 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

Medicare is establishing the following limited coverage for CPT codes 66989 and 66991.

Group 1 Codes
Code Description
H40.1111 Primary open-angle glaucoma, right eye, mild stage
H40.1112 Primary open-angle glaucoma, right eye, moderate stage
H40.1121 Primary open-angle glaucoma, left eye, mild stage
H40.1122 Primary open-angle glaucoma, left eye, moderate stage
H40.1131 Primary open-angle glaucoma, bilateral, mild stage
H40.1132 Primary open-angle glaucoma, bilateral, moderate stage

Group 2

(52 Codes)
Group 2 Paragraph

Medicare is establishing the following limited coverage for CPT code 0449T (XEN):

Group 2 Codes
Code Description
H40.10X1 Unspecified open-angle glaucoma, mild stage
H40.10X2 Unspecified open-angle glaucoma, moderate stage
H40.10X3 Unspecified open-angle glaucoma, severe stage
H40.10X4 Unspecified open-angle glaucoma, indeterminate stage
H40.1111 Primary open-angle glaucoma, right eye, mild stage
H40.1112 Primary open-angle glaucoma, right eye, moderate stage
H40.1113 Primary open-angle glaucoma, right eye, severe stage
H40.1114 Primary open-angle glaucoma, right eye, indeterminate stage
H40.1121 Primary open-angle glaucoma, left eye, mild stage
H40.1122 Primary open-angle glaucoma, left eye, moderate stage
H40.1123 Primary open-angle glaucoma, left eye, severe stage
H40.1124 Primary open-angle glaucoma, left eye, indeterminate stage
H40.1131 Primary open-angle glaucoma, bilateral, mild stage
H40.1132 Primary open-angle glaucoma, bilateral, moderate stage
H40.1133 Primary open-angle glaucoma, bilateral, severe stage
H40.1134 Primary open-angle glaucoma, bilateral, indeterminate stage
H40.1211 Low-tension glaucoma, right eye, mild stage
H40.1212 Low-tension glaucoma, right eye, moderate stage
H40.1213 Low-tension glaucoma, right eye, severe stage
H40.1214 Low-tension glaucoma, right eye, indeterminate stage
H40.1221 Low-tension glaucoma, left eye, mild stage
H40.1222 Low-tension glaucoma, left eye, moderate stage
H40.1223 Low-tension glaucoma, left eye, severe stage
H40.1224 Low-tension glaucoma, left eye, indeterminate stage
H40.1231 Low-tension glaucoma, bilateral, mild stage
H40.1232 Low-tension glaucoma, bilateral, moderate stage
H40.1233 Low-tension glaucoma, bilateral, severe stage
H40.1234 Low-tension glaucoma, bilateral, indeterminate stage
H40.1311 Pigmentary glaucoma, right eye, mild stage
H40.1312 Pigmentary glaucoma, right eye, moderate stage
H40.1313 Pigmentary glaucoma, right eye, severe stage
H40.1314 Pigmentary glaucoma, right eye, indeterminate stage
H40.1321 Pigmentary glaucoma, left eye, mild stage
H40.1322 Pigmentary glaucoma, left eye, moderate stage
H40.1323 Pigmentary glaucoma, left eye, severe stage
H40.1324 Pigmentary glaucoma, left eye, indeterminate stage
H40.1331 Pigmentary glaucoma, bilateral, mild stage
H40.1332 Pigmentary glaucoma, bilateral, moderate stage
H40.1333 Pigmentary glaucoma, bilateral, severe stage
H40.1334 Pigmentary glaucoma, bilateral, indeterminate stage
H40.1411 Capsular glaucoma with pseudoexfoliation of lens, right eye, mild stage
H40.1412 Capsular glaucoma with pseudoexfoliation of lens, right eye, moderate stage
H40.1413 Capsular glaucoma with pseudoexfoliation of lens, right eye, severe stage
H40.1414 Capsular glaucoma with pseudoexfoliation of lens, right eye, indeterminate stage
H40.1421 Capsular glaucoma with pseudoexfoliation of lens, left eye, mild stage
H40.1422 Capsular glaucoma with pseudoexfoliation of lens, left eye, moderate stage
H40.1423 Capsular glaucoma with pseudoexfoliation of lens, left eye, severe stage
H40.1424 Capsular glaucoma with pseudoexfoliation of lens, left eye, indeterminate stage
H40.1431 Capsular glaucoma with pseudoexfoliation of lens, bilateral, mild stage
H40.1432 Capsular glaucoma with pseudoexfoliation of lens, bilateral, moderate stage
H40.1433 Capsular glaucoma with pseudoexfoliation of lens, bilateral, severe stage
H40.1434 Capsular glaucoma with pseudoexfoliation of lens, bilateral, indeterminate stage
N/A

ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

Group 1 Paragraph

Any ICD-10-CM code not listed in Group 1 "ICD-10 Codes that Support Medical Necessity" section

Group 1 Codes

N/A

N/A

ICD-10-PCS Codes

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Additional ICD-10 Information

N/A

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code Description
013x Hospital Outpatient
083x Ambulatory Surgery Center
085x Critical Access Hospital
N/A

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Code Description
036X Operating Room Services - General Classification
045X Emergency Room - General Classification
049X Ambulatory Surgical Care - General Classification
076X Specialty Services - General Classification
N/A

Other Coding Information

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A N/A
N/A
Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A

Revision History Information

Revision History Date Revision History Number Revision History Explanation
07/06/2023 R8

R8
Revision Effective: 07/06/2023
Revision Explanation: Remove 0671T from group 3 CPT/HCPCS code list retro effective to 01/01/2023.

03/23/2023 R7

R7
Revision Effective: 03/23/2023
Revision Explanation: Annual review, no changes were made.

03/31/2022 R6

R6
Revision Effective: 03/31/2022
Revision Explanation: Annual review, no changes were made.

01/01/2022 R5

R5

Revision Effective : 01/01/2022

Revision Explanation: Codes 0191T and 0376T were end dated and replaced with new codes 66989 and 66991. New code 0671T was added as non covered as this is not FDa approved and code 0450T was move to non-covered as only one XEn is allowed per eye. Article text was updated to refelct the new codes and removed the information for 0450T that indicated this would be allowed..

04/01/2021 R4

R4
Revision Effective: 04/01/2021
Revision Explanation: Annual review no changes made.

03/01/2021 R3

R3
Revision Effective: 
Revision Explanation: Listed codes 0376T and 0450T as payable for perspective procedures.

12/30/2019 R2

Revision Effective: n/a

Revision Explanation: Annual review, no changes

12/30/2019 R1

R1

Revision Effective: 12/30/2019

Revision Explanation: Updating article to follow updated policy information that was taken to open meeting on June 26, 2019. New ICd-10 sections added as there are separate codes for 0191T and 0449T. Also added new codes that are not covered for these services.

N/A

Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
LCDs
L37578 - Micro-Invasive Glaucoma Surgery (MIGS)
Related National Coverage Documents
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SAD Process URL 1
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SAD Process URL 2
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Other URLs
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Public Versions
Updated On Effective Dates Status
06/26/2023 07/06/2023 - N/A Currently in Effect You are here
03/15/2023 03/23/2023 - 07/05/2023 Superseded View
03/21/2022 03/31/2022 - 03/22/2023 Superseded View
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

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