0253T — Insert aqueous drain device
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
- The medical record must support medical necessity for the service and include prior glaucoma treatments and the patient's response to those treatments.
- Every page of the record must be legible and include appropriate patient identification (e.g., full name, dates of service) and the legible signature of the physician or non-physician practitioner providing care.
- The submitted medical record must support the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
- Use specified claim fields for billing: Part A — Line SV202-7 for 837I or Block 80 for UB-04; Part B — Loop 2400 or SV101-7 for 837P or Box 19 for paper claims.
Key Coverage Criteria
- CPT 66991 may be reported for noncomplex cataract removal with intraocular lens (IOL) implant performed with concomitant intraocular aqueous drainage device insertion (e.g., iStent) when the medically reasonable and necessary criteria in the related LCD are met.
- CPT 66989 may be reported for complex cataract removal with IOL implant performed with concomitant intraocular aqueous drainage device insertion when the medically reasonable and necessary criteria in the related LCD are met.
- CPT 65820 may be reported for true goniotomy defined as incision and/or excision of trabecular meshwork for at least three clock hours via an internal approach to create an opening into Schlemm canal, reported per eye.
- Use unlisted CPT 66999 for goniopuncture or microgoniotomy procedures when no specific CPT code exists and identify the procedure in the narrative.
- CPT 0449T or 0671T may be reported for insertion of glaucoma drainage device(s) into the subconjunctival space (e.g., XEN45, iStent Infinite) when the medically reasonable and necessary criteria in the related LCD are met.
- Phacoemulsification with IOL placement may be performed together with a single MIGS procedure during the same operative session in the same eye.
20 Active Policies
L39907 — Micro-Invasive Glaucoma Surgery (MIGS)
J05
A59807 — Billing and Coding: Micro-Invasive Glaucoma Surgery
J05
L37244 — Micro-Invasive Glaucoma Surgery (MIGS)
J06
A56588 — Billing and Coding: Micro-Invasive Glaucoma Surgery (MIGS)
J06
L38233
Related Codes
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