This article gives guidance for billing, coding, and other guidelines in relation to local coverage policy for L39620-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 Information
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
CPT code 65820 Goniotomy
Goniotomy is a procedure in which trabecular meshwork is incised and/or excised with a blade or other surgical instrument for at least 3 clock hours to create an opening into Schlemm’s canal from the anterior chamber, via an internal approach through the anterior chamber and is reported with CPT code 65820.
Specifically, goniotomy (CPT® code 65820) should not be coded in addition to other angle surgeries, stent insertions or Schlemm canal implants or if the incision into the trabecular meshwork is minimal or simply incidental to another procedure. Even performing multiple goniopunctures with or without excision of tissue does not meet the CPT® description for a true goniotomy.
Effective July 1, 2020, 65820 is bundled with 66174. Both procedures cannot be reported together.
Goniotomy 65820 is per eye. For Medicare Part B patients, when a surgery is performed bilaterally, submit one line item with the surgical code appended by modifier -50, per Medically Unlikely Edits (MUEs) effective April 1, 2013. A “1” should be placed in the unit field and the charge should be doubled.
For use of ophthalmic endoscope with 65820, use 66990
CPT 66700-66711 Cyclophotocoagulation
Use CPT 66700 for ciliary body destruction, diathermy
Use CPT 66710 for cyclophotocoagulation, transscleral
Use CPT 66711 cyclophotocoagulation, endoscopic, without concomitant removal of crystalline lens
For CPC performed at the same time as extracapsular cataract removal with intraocular lenses insertion use CPT 66987 or 66988. Do not report 66711 in conjunction with 66990.
CPT code 66174 Canaloplasty
When transluminal dilation (eg, canaloplasty) is performed for at least 3 clock hours and the trabecular meshwork is opened (eg, goniotomy) for at least 3 clock hours, report CPT code 66174.
Viscoelastic injections made via 3 or more punctures of the trabecular meshwork spanning at least 3 clock hours (90 degrees) to dilate Schlemm’s canal should also qualify as canaloplasty, CPT code 66174. Any surgery less is reported with CPT code 66999.
CPT 0621T or 0622T
Excimer laser trabeculostomy (ie, ExTra ELT) should be billed with CPT Code® 0621T or 0622T.
Unspecified Procedure CPT 66999
The following should be reported with CPT code 66999:
- gonioscopy-assisted transluminal trabeculotomy (GATT)
- transciliary fistulization (transciliary filtration, Singh filtration)
- viscocanalostomy (including phacoviscocanalostomy)
- Transciliary Fistulization for the Treatment of Glaucoma
Since there is no specific CPT® code for goniopuncture or so-called microgoniotomy procedures, the unlisted CPT® code 66999 (unlisted procedure, anterior segment of the eye) should be reported in these instances.
Any procedures performed which consist of single or multiple small punctures and/or injection of small amounts of viscoelastic, or other limited interventions should be reported using unlisted CPT® code 66999.
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®, iStent inject W®,), when performed in conjunction with cataract surgery on the date of service 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 1 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 1 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 or 0671T for insertion of glaucoma drainage device(s) into the subconjunctival space (e.g., XEN45®, iStent Infinite®), when the medically reasonable and necessary criteria as stated in the LCD are met.
Multiple Procedure Limitations
Phacoemulsification can be performed in conjunction with a single MIGS procedure, stent or surgical, but not both at same time of service.
Reporting of a combination of MIGs procedures (other than phacoemulsification) at the same time of service in the same patient or risk denial of the entire claim. A combination of services is more than one device or surgical technique applied at the same time. If a device (eg. OMNI) performs more than one procedure at the same time that is not considered separate services.
Documentation Requirements
- 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.
- 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.
- 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.
