iStent infinite® Coding and Reimbursement: US Healthcare Providers Only
Updated: August 10, 2022
Payer guidelines are subject to change without notice.
2022 Billing and Coding Guide
Approved Indications for iStent infinite®
|The iStent infinite® Trabecular Micro-Bypass System Model iS3 is an implantable device intended to reduce the intraocular pressure (IOP) of the eye. It is indicated for use in adult patients with primary open-angle glaucoma in whom previous medical and surgical treatment has failed.|
Coding Options for iStent infinite®
|0671T||Insertion of anterior segment aqueous drainage device into the trabecular meshwork, without external reservoir, and without concomitant cataract removal, one or more||-LT (left side), or
-RT (right side)
The following HCPCS codes may be appropriate for reporting when iStent infinite is used, and the number of service units for the code reported may correspond to the number of stents deployed.
|HCPCS Code||Description||Revenue Code|
|C1783||Ocular implant; aqueous drainage assist device||0278; other implants|
|L8612||Aqueous shunt||0278; other implants|
The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) is the coding system used to report patient diagnoses. Diagnosis codes are used to document the indication for the procedure and may include additional diagnoses of other clinical conditions applicable to a healthcare visit. It is up to the provider to determine the appropriate diagnosis code(s) on the claim.
- H40.XXXX – Glaucoma
Claims Submission Process
Each provider is responsible for ensuring all claims are accurately coded and submitted on a timely basis. Fully documented claims helps to minimize delay in proper reimbursement.
Other Coverage Information
Private payers may require a prior authorization before performing the iStent infinite® procedure.
Please check with your local Glaukos Regional Business Manager or Field Reimbursement Director for the latest updates on coverage in your area. Your Glaukos reimbursement team can be reached at firstname.lastname@example.org
2022 National Average Unadjusted Medicare Payment
Private payers each employ their own methodology to determine payment amounts for services based on the CPT, ICD-10 and HCPCS codes billed on the claim and payment will be contingent upon the contractual agreement.
Facility billing departments should check the service contracts with individual private payers or contact each payer directly to verify the applicable reimbursement methodologies and/or amounts for the iStent infinite® implantation. All HOPDs must include the iStent infinite® device on their claim forms to payers in order to capture the full cost of providing the service.
Medicare will package the device reimbursement with the surgical facility payment for 0671T, some commercial payer claims in the Ambulatory Surgery Center setting may pay a carve-out for the iStent infinite® implant. A review of the specific payer’s requirement is recommended.
|0671T||Insertion of anterior segment aqueous drainage device into the trabecular meshwork, without external reservoir, and without concomitant cataract removal, one or more||$1601||$2121|
iPath360 is available to assist iStent infinite® providers with coding, billing, and reimbursement questions and to provide additional support.
To engage with iPath360, please call (844) 528-3311 or email us at email@example.com
Glaukos provides this coding guide for informational purposes only and it is subject to change without notice. This guide is not an affirmative instruction as to which codes and modifiers to use for a particular service, supply, procedure or treatment and does not constitute advice regarding coding, coverage, or payment for Glaukos products. It is the responsibility of providers, physicians and suppliers to determine and submit appropriate codes, charges and modifiers for products, services, supplies, procedures, or treatment furnished or rendered. Providers, physicians and suppliers should contact their third-party payers for specific and current information on their coding, coverage, and payment policies. For further detailed product information, including indications for use, contraindications, effects, precautions and warnings, please consult the product’s Instructions for Use (IFU) prior to use. The information provided herein is without any other warranty or guarantee of any kind, expressed or implied, as to completeness, accuracy, or otherwise. This information is intended only to help estimate Medicare payment rates and product costs in the hospital outpatient department setting. All rates shown are national average Medicare rates and have not been adjusted for geographic variations in payment or other factors, such as sequestration.
- † Listed payment amounts are Medicare national average rates that are not adjusted (such as for locality or sequestration). The rates are from the July 2022 Addendum AA – ASC Covered Surgical Procedures for CY 2022, available at: https://www.cms.gov/apps/ama/license.asp?file=/files/zip/2022-july-asc-addenda.zip.
- ‡ https://www.cms.gov/medicaremedicare-fee-service-paymenthospitaloutpatientppsaddendum-and-addendum-b-updates/july-2022-0.
- ¶ Listed payment amounts are Medicare national average rates that are not adjusted (such as for locality or sequestration). For procedures assigned to a new technology APC, such as CPT codes 66989 and 66991, Medicare payment is made even if included on a claim with a procedure assigned to a comprehensive APC. 83 Fed. Reg. 58818, 58847 (Nov. 21, 2018). The rates are from the 2022 Correction Notice OPPS Addendum B, available at https://www.cms.gov/medicaremedicarefee-service-paymenthospitaloutpatientppshospital-outpatient-regulations-and-notices/cms-1753-cn.