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Medicare Reimbursement for Endoscopic Cyclophotocoagulation (Endo Optiks)

FREQUENTLY ASKED QUESTIONS: 

MEDICARE REIMBURSEMENT FOR ENDOSCOPIC CYCLOPHOTOCOAGULATION

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Q  What is endoscopic cyclophotocoagulation (ECP)?

A  ECP is a cyclodestructive procedure. It uses a microendoscope with 3 elements: (1) an image guide, (2) a light source, and (3) a laser.1 The surgeon has direct visualization of the ciliary processes, which enables precise delivery of laser energy and limits damage to the underlying ciliary body and neighboring tissue. ECP minimizes the disadvantages of trans-scleral cyclodestructive procedures while maximizing the advantage of ablating the ciliary body epithelium to decrease intraocular pressure.

 

Q  What is the indication for ECP?

A  Endoscopic cyclophotocoagulation is indicated for treatment of glaucoma in patients who have failed with conventional topical and systemic medications, previous laser photocoagulation, trabeculectomy and other filtering procedures, cyclocryotherapy, or other cyclodestructive procedures.2

 

Q  Does ECP have FDA approval?

A  Yes, the Uram Ophthalmic Laser Endoscope was approved by the FDA in 1991.3

 

Q  What CPT codes should be used for ECP?

A  For all procedures prior to January 1, 2020, 66711 is the exclusive code for ECP. Use also codes 66982 or 66984 when performed concurrently with cataract surgery. Effective January 1, 2020, 66711 is used only when ECP is not performed at the same time as cataract surgery. If ECP is performed with cataract surgery, new codes 66987 and 66988 apply. Furthermore, for 2020, codes 66982 and 66984 specifically added “without endoscopic cyclophotocoagulation.” 4

  • 66711 Ciliary body destruction; cyclophotocoagulation, endoscopic, without concomitant removal of crystalline lens
  • 66987 Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique (e.g., irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine cataract surgery (e.g., iris expansion device, suture support for intraocular lens, or primary posterior capsulorrhexis) or performed on patients in the amblyogenic developmental stage; with endoscopic cyclophotocoagulation
  • 66988 Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (e.g., irrigation and aspiration or phacoemulsification); with endoscopic cyclophotocoagulation

 

Q  What insurance coverage limitations exist?

A  Currently, there exist no national or local coverage Medicare policies pertaining to ECP. Unlike temporary Category III codes, claims for reimbursement are not typically a problem for ECP.

 

Q  What are the 2020 Medicare reimbursement rates for ECP?

A  For CY 2020, the national Medicare payment rates are:

No RVUs are assigned to 66987 or 66988 so the Medicare Administrative Contractors (MACs) are required to determine the payments to surgeons.

 

Q  What procedures are bundled with ECP?

A  According to the January 1, 2020, National Correct Coding Initiative edits, 66711 is bundled with a large number of noncataract procedures and many other glaucoma procedures.7

1 Seigel MJ. Endoscopic cyclophotocoagulation (ECP). The US Food and Drug Administration. Link here. Accessed 12/10/19.
2 The US Food and Drug Administration. Special 510(k) Summary for Microprobe Laser and Endoscopy System. K042918. 10/18/2004. Link here. Accessed 12/10/19.
3 510(k) clearance Uram Ophthalmic Laser Endoscope. K910532 05/28/1991. Link here. Accessed 12/10/19.
4 CPT Professional 2020.
5 CMS-1715-F and IFC. 84 FR 62568. Published 11/15/19. PFS Final Rule Addendum B. Link here. Accessed 12/10/19
6 CMS-1717-FC. 84 FR 61142. Published 11/12/19. 2020 NFRM Addendum B. Link here. Accessed 12/10/19.
7 Q4 2019 NCCI edits. Link here. Accessed 12/10/19.

 

Provided Courtesy of Endo Optiks www.endooptiks.com (800) 756-3636

Last updated January 1, 2020

The reimbursement information is provided by Corcoran Consulting Group based on publicly available information from CMS, the AMA, and other sources. The reader is strongly  encouraged to review federal and state laws, regulations, code sets, and official instructions promulgated by Medicare and other payers. This document is not an official source nor is it a complete guide on reimbursement. Although we believe this information is accurate at the time of publication, the reader is reminded that this information, including references and hyperlinks, changes over time, and may be incorrect at any time following publication.

© 2020 Corcoran Consulting Group. All rights reserved. No part of this publication may be reproduced or distributed in any form or by any means, or stored in a retrieval system, without the written permission of the publisher. CPT is a registered trademark of the American Medical Association.

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