0100T — Prosth retina receive&gen
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- Office outpatient and hospital inpatient medical records must clearly document how each of the above indications was met.
- When submitting a claim for CPT 0100T, include ICD-10 code H35.52 on the claim.
- For replacement parts bill L8608 and include the name of the part being replaced and invoice information with the claim.
- Device was approved under a Humanitarian Device Exemption (HDE); ensure any HDE-specific documentation or identifiers are retained as required by payer policy.
Key Coverage Criteria
- Diagnosis of severe to profound retinitis pigmentosa documented in the medical record.
- Patient age 25 years or older at time of implantation.
- Bare light perception or no light perception in both eyes.
- If the patient has no residual light perception, documented evidence of intact inner retinal layer function must be confirmed prior to implant.
- Previous history of useful form vision documented in the record.
- Patient is aphakic or pseudophakic, or if phakic will undergo removal of the natural lens during the implant procedure.
2 Active Policies
A54327 — Billing and Coding: ArgusM II Retinal Prosthesis System
REGENCE-SUR194 — Retinal Prosthesis
Related Codes
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