66183
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
12.87
Facility
$881.45
Non-Facility
$881.45
Documentation Required
- A valid ICD-10-CM diagnosis code that best describes the patient's condition for which the service was performed must be reported on the claim; claims without a valid ICD-10-CM code will be returned as incomplete under Section 1833(e).
- For services that require a referring/ordering physician, the referring/ordering physician's name and NPI must be reported on the claim.
- For Part A inpatient claims, report the principal diagnosis in UB-04 FL 67, up to eight additional diagnoses in FLs 67A-67Q, and the admitting diagnosis in FL 69 as required.
- For hospital outpatient claims report the full ICD-10-CM code for the diagnosis chiefly responsible for outpatient services in FL 67, or if no definitive diagnosis, report the presenting symptom or Z00.00–Z13.9 as appropriate.
Key Coverage Criteria
- Glaucoma filtering surgery, including insertion of an anterior segment aqueous drainage device without extraocular reservoir, is indicated when glaucomatous damage progresses despite pharmacological and/or prior surgical treatment.
- Insertion of an anterior segment aqueous drainage device (no extraocular reservoir) may be used as an alternative or adjunct to guarded trabeculectomy for patients with advanced glaucoma who require very low intraocular pressure and who are at high risk for hypotony-related complications.
- The device used for the procedure must be FDA-approved (e.g., Ex-PRESS™ mini shunt) to be covered.
- Use CPT 66991 for noncomplex cataract removal with insertion of intraocular lens (IOL) implant and concomitant intraocular aqueous drainage device when LCD medically reasonable and necessary criteria are met.
- Use CPT 66989 for complex cataract removal with IOL implant and concomitant intraocular aqueous drainage device when LCD medically reasonable and necessary criteria are met.
- Report goniotomy with CPT 65820 when the trabecular meshwork is incised and/or excised for at least three clock hours to create an opening into Schlemm canal from the anterior chamber; 65820 is reported per eye.
18 Active Policies
A56588 — Billing and Coding: Micro-Invasive Glaucoma Surgery (MIGS)
J06
L37244 — Micro-Invasive Glaucoma Surgery (MIGS)
J06
A56491 — Billing and Coding: Micro-Invasive Glaucoma Surgery (MIGS)
A56866 — Billing and Coding: Micro-Invasive Glaucoma Surgery (MIGS)
A57863 — Billing and Coding: Micro-Invasive Glaucoma Surgery (MIGS)
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.