Reimbursement for Micropulse Transscleral Cyclophotocoagulation (Iridex)
FREQUENTLY ASKED QUESTIONS:
REIMBURSEMENT FOR MICROPULSE TRANSSCLERAL CYCLOPHOTOCOAGULATION
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Q What is MicroPulse® transscleral cyclophotocoagulation?
A MicroPulse® transscleral cyclophoto-coagulation (MP-TSCPC), or MicroPulse transscleral laser therapy (MP-TLT), employs a fractionated continuous wave diode laser (810 nm) which targets melanin in a non-destructive way in ciliary body tissues, the tissue responsible for production of aqueous humor. Chopping the continuous wave (CW) of laser energy into micropulses allows a significant and clinically efficacious amount of heat to be applied to target tissues while allowing the heat to dissipate between pulses, preserving the efficacy while preventing unwanted tissue damage.1
Q What are the indications for MP-TSCPC?
A CW-TSCPC has primarily been used to lower intraocular pressure in cases of refractory glaucoma. Whereas traditional CW-TSCPC is typically only used in refractory cases with poor visual potential, MP-TSCPC can be used in seeing eyes with good visual potential. It can be performed for a variety of glaucomas, before or after incisional glaucoma surgery, and in combination with other treatments. The procedure is well suited for younger individuals (>45 y/o) and also older individuals (>65 y/o).2
Q What CPT code is used in the United States to report MP-TSCPC?
A Report MP-TSCPC with CPT 66710, Ciliary body destruction; cyclophotocoagulation transscleral. This is the same code used for CW-TSCPC since CPT is agnostic to the type of laser and the probe delivery device.
Q Is 66710 covered and reimbursed by Part B Medicare?
A Claims to Part B (traditional or ordinary) Medicare are evaluated by the MACs on an individual basis and generally paid. There are currently no Medicare Part B policies for 66710 because it is a relatively infrequent procedure. Commercial policies are very few; practices are advised to get prior authorization from payers.3,4,5
Q What is the global surgery period for 66710?
A 66710 has a 90-day global surgical period and is a major procedure under Medicare’s regulations.
Q What is the Medicare physician reimbursement for MP-TSCPC?
A When MP-TSCPC is performed in the physician’s office, the 2021 national Medicare Physician Fee Schedule allowed amount is $459 for participating providers. When MP-TSCPC is performed in an ambulatory surgery center (ASC) or hospital outpatient department (HOPD), the surgeon’s Medicare allowable is reduced to $394 due to the site-of-service differential. Medicare fee schedule amounts are adjusted by local wage indices so actual payment amounts vary.
Q Does Medicare allow a facility fee for MP-TSCPC?
A Yes, 66710 is eligible for a facility fee. The 2021 national ambulatory surgery center (ASC) allowed amount is $854; in the hospital outpatient department (HOPD), it is $2,002. Allowed amounts are adjusted by local indices.
Q How can I be reimbursed for MP-TSCPC on the fellow eye during the 90-day postop period?
A Use modifier 79 with 66710 on your claim to indicate that the second MP-TSCPC procedure is unrelated to the first. Location modifiers RT or LT are also helpful.
Q Can MP-TSCPC be reimbursed if performed on both eyes on the same day?
A Yes. CPT guidelines for bilateral surgery and recent Medicare guidelines for Medically Unlikely Edits (MUE) direct you to report bilateral TSCPC as 66710-50 with a quantity of “1” for the surgeon; facilities generally report 2 lines with RT and LT. Under the multiple procedure rules, reimbursement is based on 150% of the Medicare allowable for a single procedure. Most other payers agree.
Q Can I be reimbursed for a repeat MP-TSCPC on the same eye?
A Yes. When the surgeon believes additional treatment is medically necessary and properly documents the rationale for repeating it, it is covered. Repeat CW-TSCPC treatments are mentioned in the scientific literature.6 MP-TSCPC can also be repeated in eyes without successful outcome after the initial treatment, though there is little available evidence on retreatment outcomes.7
Q Can a surgeon share or co-manage postop care for 66710?
A Yes, subject to the limitations in the Medicare policy and applicable state laws. The guidance of professional societies on co-management is a further consideration.
1. Toyos, MM, Toyos, R. Clinical Outcomes of Micropulsed Transscleral Cyclophotocoagulation in Moderate to Severe Glaucoma. J Clin Exp Ophthalmol 2016, 7:6 Link here.
2. American Academy of Ophthalmology EyeWiki. Micropulse Transscleral Cyclophotocoagulation. Link here.
3. United Healthcare Outpatient Surgical Procedures – Site of Service August, 2021 Link here
4. ConnectiCare Medical Policy : Glaucoma January, 2021 Link here
5. Aetna Clinical Policy Bulletin 0484 Link here.
6. Bloom, PA, Tsai, JC, Sharma, K, et al. Transscleral Diode Laser Cyclophotocoagulation in the Treatment of Advanced Refractory Glaucoma. Ophthalmol Vol 104 Issue 9 p 1508-1520 September 1, 1997 Link here.
7. AAO EyeWiki Cyclodestructive Procedures in Treatment of Glaucoma Link here.
Provided Courtesy of Iridex
Last updated October 20, 2021
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.
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