The reimbursement angle on aniridia – Ophthalmology Management

Aniridia is a rare condition defined as the full or partial absence of the iris. Most often it occurs as a result of a traumatic injury; less often, it is a congenital abnormality. The patient is severely handicapped due to photophobia from too much light. There is a lengthy history of treatments for aniridia, notably tinted contact lenses — the problem being that many patients are contact-lens intolerant. At the present time, the most promising treatment is an iris prosthesis or artificial iris.

The question is, how does reimbursement work?

This article addresses the following questions:

  • What are the indications for an artificial iris?
  • How is it implanted?
  • Will Medicare cover an artificial iris and its implantation?
  • What CPT code is used to report the procedure?
  • How does payment work for the surgeon?
  • What is the Medicare payment to the facility?
  • What about the prosthetic device itself?

This article was published in Ophthalmology Management’s Coding & Reimbursement column, which is written by Corcoran’s Executive Vice-President, Suzanne Corcoran, COE. To view the entire article in Ophthalmology Management, click on the link below:;-reimbursement

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