The fastest growing treatment for glaucoma is minimally invasive glaucoma surgery (MIGS), particularly implantation of an aqueous drainage device (ADD) by an internal approach. In 2022, we have new codes for these procedures.

Q. What are the new codes, and how are they used?

A. In 2022, we have three new codes for these procedures: 66991, 66989 and 0671T; the prior codes, 0191T and +0376T, were 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.
• 0671T – Insertion of anterior segment aqueous drainage device into the trabecular meshwork, without external reservoir, and without concomitant cataract removal, one or more.

Q. Do Medicare and other payers cover implantation of an ADD as described by these codes?

A. All Medicare Administrative Contractors (MACs) and most other payers cover 66989 and 66991 when performed in accordance with FDA-approved directions for use, in conjunction with medically necessary cataract surgery. Currently no coverage is available for the stand-alone ADD procedure 0671T because the procedure is still in clinical trials, not FDA approved; it is experimental and investigational.

Q. What does Medicare allow for these procedures?

A. For the surgeon, the 2022 national Medicare Physician Fee Schedules (MPFS) allowed amount for 66991 is $683, and $857 for 66989. The MPFS for 0671T has no defined allowed amount.

For the facility, the procedures are paid under APC 1563. The 2022 AS-allowed amount for 66989 and 66991 is $3,246. For a hospital outpatient department (HOPD), it is $4,251. For 0671T, the allowed amounts are $1,601 and $2,121 respectively, although no claims are paid at this time.

Q. Is separate Part B Medicare reimbursement available for the ADD?

A. No. Part B Medicare payment for the device is included in the facility reimbursement. For tracking purposes, on a UB-04 claim, the facility reports HCPCS code C1783 with revenue code 278 to identify the ADD. There is no separate reporting of 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 device 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. Are there bundles for CPT 66989 and 66991?

A. Yes. Medicare’s NCCI edits include cataract procedures and some glaucoma procedures. NCCI edits are updated quarterly. Most third-party payers follow NCCI edits, but not all; check your payer contracts.

Q. What is the global period for 66989 and 66991?

A. In the MPFS, the global period for 66989 and 66991 surgery is 90 days.

Q. Can a surgeon comanage postoperative care for 66989 and 66991?

A. Yes, sometimes. Medicare’s rules for splitting postoperative care during the 90-day global period between the surgeon and another physician apply. The CMS regulations and the professional society guidance on this issue are especially meaningful and relevant for a combined cataract and MIGS procedure (See CMS’s Global Surgery Booklet, tinyurl.com/mrybyc73 ; ASCRS’s Ophthalmic Postoperative Care, tinyurlcom/9322sc8h ; and AAO’s Guidelines for the Comanagement of Ophthalmic Postoperative Care, tinyurl.com/mtcxtem5 ).

Q. What products are currently on the US market?

A. At present, two products are available: Glaukos’ iStent and Ivantis’ Hydrus, approved by the FDA “…for use in conjunction with cataract surgery for the reduction of intraocular pressure (IOP) in adult patients with mild or moderate open-angle glaucoma ...” OM

Suzanne L. Corcoran, COE is vice president of Corcoran Consulting Group. She can be reached at (800) 399-6565 or www.corcoranccg.com .