Medicare Reimbursement for Hydrus Microstent (Ivantis)
FREQUENTLY ASKED QUESTIONS:
MEDICARE REIMBURSEMENT FOR THE HYDRUS MICROSTENT
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Q What is the Ivantis Hydrus® Microstent?
A The Hydrus Microstent is an 8 mm, biocompatible, flexible, nitinol (i.e., alloy of nickel and titanium) device designed to be inserted into Schlemm’s canal through an opening in the trabecular meshwork using a unique delivery system. It functions as an intracanalicular scaffold to facilitate aqueous drainage from the anterior chamber.1
Q What are the indications for the Hydrus Microstent?
A As approved by the FDA in August 2018, the Hydrus Microstent “…is indicated for use in conjunction with cataract surgery for the reduction of intraocular pressure (IOP) in adult patients with mild to moderate primary open-angle glaucoma (POAG). It is contraindicated in eyes with traumatic, malignant, uveitic, or neovascular glaucoma or discernible congenital anomalies of the anterior chamber angle, [and] in eyes with angle closure glaucoma.”2
Q Do Medicare and other payers cover implantation of the Hydrus Microstent?
A Yes, all Medicare Administrative Contractors (MACs) cover these procedures when performed in accordance with the FDA-approved directions for use, and in conjunction with medically necessary cataract surgery. Most other payers also consider these covered procedures.
Q Is there reimbursement for stand-alone Hydrus implantation without cataract surgery?
A Not at present because the procedure is still in clinical trials, not FDA approved, and is experimental and investigational.
Q What CPT code describes implantation of the Hydrus?
A In 2022, there are 2 new codes for the implantation of Hydrus with cataract surgery: 66991, 66989; the prior code, 0191T, was deleted.
66991 – Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification); with insertion of intraocular (eg, trabecular meshwork, supraciliary, suprachoroidal) anterior segment aqueous drainage device, without extraocular reservoir, internal approach, one or more.
66989 –Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine cataract surgery (eg, iris expansion device, suture support for intraocular lens, or primary posterior capsulorrhexis) or performed on patients in the amblyogenic developmental stage; with insertion of intraocular (eg, trabecular meshwork, supraciliary, suprachoroidal) anterior segment aqueous drainage device, without extraocular reservoir, internal approach, one or more.
Q What does Medicare allow for these procedures?
A The 2022 national Medicare amounts are as follows. These amounts are adjusted in each area by local wage indices. Other payers set their own rates, which may differ significantly from Medicare’s.
Q Is there separate Part B Medicare reimbursement for the Hydrus Microstent device?
A No. Part B Medicare payment for the device is included in the facility reimbursement for APC 1526. On a UB-04 claim, use HCPCS code C1783 with revenue code 278 to identify the ADD.3 Do not report a HCPCS code for the device on a CMS-1500 claim. For other third-party payers, check their instructions and your contract.
Q May gonioscopy (92020) be billed with the claim for the surgery?
A No. Gonioscopy is required during surgery to implant the Hydrus and is an incidental part of the service. CPT instructs that a code designated as a “separate procedure”, such as gonioscopy, should not be reported in addition to the code for the total procedure of which it is considered an integral component.
Q What is the global period for 66989 and 66991?
A In the Medicare Physician Fee Schedule, the global period for 66991 and 66989 surgery is 90 days.
1 Laspas, P. Minimally Invasive Glaucoma Surgery. Nov 2020. Link here. Accessed 12/17/21
2 Hydrus Microstent Instructions for Use
3 CMS requires HOPDs to report C1783 (Ocular implant, aqueous drainage assist device) on Medicare claims for tracking purposes, although it does not garner additional payment.
Provided courtesy of Ivantis, Inc.
Last updated January 10, 2022
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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