Reimbursement for Intrastromal Corneal Ring Segments (OASIS Medical)

This monograph addresses the reimbursement issues associated with the surgical treatment of keratoconus with intrastromal corneal ring segments (ICRS), and particularly with Intacs® prescription inserts.

In July, 2004, the FDA granted a Humanitarian Device Exemption (HDE) for the Intacs prescription inserts for keratoconus (H040002).  Reimbursement for this surgical procedure and the Intacs themselves involves a number of issues.  These include indications for surgery, coding for the surgical procedure, coding for ICRS, and the coverage policy of third party payers.  Since technology advances faster than the payment policies of payers, physicians and other providers frequently experience frustration with reimbursement issues. 

In this document, we identify the applicable CPT, HCPCS, ICD codes, and modifiers for filing claims.  We discuss practical considerations related to prior authorization, patient financial responsibility, and appeal of denied claims.  We discuss expected utilization in the context of FDA’s expectations and in contrast to corneal transplant surgeries.

 

 

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Provided Courtesy of OASIS Medical.

 

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