Medicare Reimbursement For MicroPulse® Transscleral Cyclophotocoagulation (Iridex)

This monograph addresses the reimbursement issues associated with MicroPulse® transscleral cyclophotocoagulation (TSCPC). MicroPulse TSCPC by IRIDEX® is differentiated from other ophthalmic laser therapies because it is a tissue-sparing solution for the treatment of glaucoma.

Much of the information in this document is taken from official publications of the Medicare program. The reader is encouraged to check with the local Medicare Administrative Contractor (MAC) for additional information and instructions. For other third-party payers, we have used the coding concepts contained in CPT (Current Procedural Terminology), published by the American Medical Association; diagnosis codes are from ICD-10-CM. Documentation of laser surgery, and the medical rationale for it, are key to reimbursement so we describe the required elements in detail.

Since economic analyses are a necessary part of any capital budgeting decision, we incorporated Medicare’s payment rates for TSCPC, as well as recent Medicare utilization rates.

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