The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Micro-Invasive Glaucoma Surgery (MIGS) L37531.
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 intraocular lens implant and concomitant intraocular aqueous drainage device, 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 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's canal implants or if the incision into the trabecular meshwork is minimal or simply incidental to another procedure. Performing multiple goniopunctures with or without excision of tissue does not meet the CPT® description for a true goniotomy.
Goniotomy 65820 is per eye. For Medicare Part B patients, when a surgery is performed bilaterally, submit 1 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.
Effective July 1, 2020, 65820 is bundled with 66174. Both procedures cannot be reported together.
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 and the procedure performed identified within the narrative.
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®) when performed in conjunction with cataract surgery on the date of service and when the medically reasonable and necessary criteria as stated in the related LCD are met. Although more than 1 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., XEN®45, iStent Infinite®), when the medically reasonable and necessary criteria as stated in the related LCD are met.
Multiple Procedure Limitations
Phacoemulsification/intraocular lens placement can be performed with a single MIGS procedure.
Phacoemulsification/intraocular lens placement performed with a combination of a MIGS procedure (e.g., cataract + stent + canaloplasty or goniotomy) at the same time of service in the same eye is non-covered and risks denial of the entire claim.
Phacoemulsification/intraocular lens placement and aqueous shunt may be performed in the same procedure, but an additional procedure (e.g. goniotomy or canaloplasty) cannot be performed at the same time and risk denial of the entire claim.
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.
- The documentation must include previous treatments and response to the treatment.
- 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.
