Reimbursement for CUSTOMFLEX ARTIFICIALIRIS

Topic: Artificial Iris

Sponsor: Veo Ophthalmics

Updated: 01/01/2020

Veo Ophthalmics

This monograph describes reimbursement for surgery to implant the HumanOptics CUSTOMFLEX® ARTIFICIALIRIS.

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 and published by the American Medical Association; diagnosis codes are from ICD-10-CM.

Documentation of surgery, and the medical rationale for it, is key to reimbursement so we describe the required elements in detail. For added perspective, we discuss the current Medicare payment rates for both surgeons and facilities.