Reimbursement
iStent inject® W Coding and Reimbursement: US Healthcare Providers Only
Updated: March 8, 2024
Payer guidelines are subject to change without notice.
2024 Billing and Coding Guide with Sample Claim Forms
Approved Indications for iStent inject® W
| The iStent inject® W Trabecular Micro-Bypass System Model G2-W is indicated for use in conjunction with cataract surgery for the reduction of intraocular pressure (IOP) in adult patients with mild to moderate primary open-angle glaucoma. |
Coding Options for iStent inject® W
CPT®1 Codes
| CPT Code | Descriptor | Modifiers |
|---|---|---|
| 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 development stage; with insertion of intraocular (eg, trabecular meshwork, supraciliary, suprachoroidal) anterior segment aqueous drainage device, without extraocular reservoir, internal approach, one or more. |
-LT (left side), or |
| 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. |
-LT (left side), or |
HCPCS Codes
Hospital outpatient departments (HOPDs) must report all items and services using the correct HCPCS codes. Failure to report the HCPCS code may result in incorrect payment. Some ASC claims to commercial payers may also require the inclusion of a HCPCS code. ASCs should review their payer provider contracts for guidance.
| HCPCS Code | Description | Revenue Code |
|---|---|---|
| C1783 | Ocular implant; aqueous drainage assist device | 0278; other implants |
| L8612 | Aqueous shunt | 0278; other implants |
Diagnosis Codes
In all cases, it is ultimately the responsibility of the provider to report the ICD-10-CM diagnosis code that most accurately describes the patient’s condition.
The following possible ICD-10-CM diagnosis codes describe conditions that are consistent with the FDA labeled indication for iStent inject® W.
- 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
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.
Coverage Highlights
| iStent inject® W is broadly covered by both Medicare Administrative Contractors (MACs) as well as the majority of commercial payers. |
Private payers may require a prior authorization before performing the iStent inject® W procedure.
Please check with your local Glaukos Regional Business Manager or Field Reimbursement Director for the latest updates on coverage in your area.
2024 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 inject® W implantation, the associated cataract procedure and for the iStent inject® W device itself. All HOPDs must include the iStent inject® W device on their claim forms to payers in order to capture the full cost of providing the service.
While many commercial payers will package the device reimbursement with the surgical facility payment for 66989/66991, some commercial payer claims in the Ambulatory Surgery Center setting may pay a carve-out for the iStent inject® W implant. A review of the specific payer’s requirement is recommended.
| CPT Code | Descriptor | Physician Payment* |
Ambulatory Surgical Center (ASC) Payment† |
Hospital Outpatient Department (HOPD) Payment¶ |
|
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 development stage; with insertion of intraocular (eg, trabecular meshwork, supraciliary, suprachoroidal) anterior segment aqueous drainage device, without extraocular reservoir, internal approach, one or more |
$845 |
$3665 |
$4980 |
|
66991 |
Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification); without endoscopic cyclophotocoagulation with insertion of intraocular (eg, trabecular meshwork, supraciliary, suprachoroidal) anterior segment aqueous drainage device, without extraocular reservoir, internal approach, one or more |
$675 |
$3733 |
$4980 |
iPath360 is available to assist iStent inject® W providers with coding, billing, and reimbursement questions and to provide additional support, including:
- Prior authorization guidance
- Letter templates
- General coding and billing recommendations
- Assistance with denied claims
- Guidance for commercial contracting issues
To engage with iPath360, please call (844) 528-3311 or email us at support@ipath360.net
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.
- CPT is a registered trademark of the American Medical Association (AMA). Copyright 2022 AMA. All rights reserved.
- * Listed payment amounts are Medicare national average rates that are not adjusted (such as for locality or sequestration). The rates are from the 2022 National Physician Fee Schedule Relative Value File January Release, available at: https://www.cms.gov/files/zip/rvu22a.zip.
- † Listed payment amounts are Medicare national average rates that are not adjusted (such as for locality or sequestration). The rates are from the January 2022 Addendum AA – ASC Covered Surgical Procedures for CY 2022, available at: https://www.cms.gov/license/ama?file=/files/zip/january-2022-asc-approved-hcpcs-code-and-payment-rates-updated-01122022.zip.
- ‡ https://www.federalregister.gov/documents/2022/01/13/2022-00573/medicare-program-hospital-outpatient-prospective-payment-and-ambulatory-surgical-center-payment.
- ¶ 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/medicaremedicare-fee-service-paymenthospitaloutpatientppshospital-outpatient-regulations-and-notices/cms-1753-cn.