CUSTOMFLEX® ARTIFICIALIRIS Reimbursement Support
Billing Overview
Three (3) Category III CPT codes have been assigned for reporting surgeries with the CUSTOMFLEX® ARTIFICIALIRIS prosthesis as of 7/1/20. They are:
Insertion of iris prosthesis, including suture fixation and repair or removal of iris, when performed; without removal of crystalline lens or intraocular lens, without insertion of intraocular lens
• 0616T
Insertion of iris prosthesis, including suture fixation and repair or removal of iris, when performed; with removal of crystalline lens and insertion of intraocular lens
(Do not report 0617T in conjunction with 66982, 66983, 66984)
• 0617T
Insertion of iris prosthesis, including suture fixation and repair or removal of iris, when performed; with secondary intraocular lens placement or intraocular lens exchange
(Do not report 0618T in conjunction with 66985, 66986) (Do not report 0616T, 0617T, 0618T in conjunction with 66600, 66680, 66682)
• 0618T
Because the CUSTOMFLEX® ARTIFICIALIRIS is used in a variety of situations, often to repair serious injuries to the iris and adjacent tissues, it may be one part of a compound procedure that includes surgery of the cornea, anterior chamber angle, vitreous and retina.
In 2024, each Medicare Administrative Contractor determines the surgeon’s reimbursement for 0616T, 0617T, and 0618T. CMS established 2024 payment rates for hospital outpatient departments (HOPD) and ambulatory surgery centers (ASC). These payments are inclusive of the device and facility fee. The payment rates listed are the national unadjusted rates; actual payment rates are geographically adjusted according to the wage index.
HOPD will report the charges for the device (CUSTOMFLEX® ARTIFICALIRIS) on a claim using code C1839 (Iris prosthesis). C1839 is a non-payable code but must be reported, along with 1 of the artificial iris CPT codes, for the claims to be billed correctly.
ASC will only report the appropriate CPT code for the artificial iris implantation and will not report C1839.
Diagnosis code Q13.1, for aniridia, should be present on all artificial iris claims.
For more information, please see the attached documents above.
