The Hydrus Microstent is covered by insurance plans across the United States. Understand and communicate your patient’s coverage as part of your consultation and remember that payer guidelines are subject to change without notice.
Updated February 7, 2020
Medicare Reimbursement for the Hydrus Microstent
Indications for Use:
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).
2020 National Average Unadjusted Medicare Payment*
Hospital outpatient departments (HOPDs) must report all items and services using the correct HCPCS codes. Failure to report the HCPCS code may result in incorrect payment. Some ASC claims to commercial payers may also require the inclusion of a HCPCS code. ASCs should review their payer provider contracts for guidance.
Examples of Pertinent ICD Diagnosis Codes*
|H40.10X1||Unspecified open-angle glaucoma, mild stage|
|H40.10X2||Unspecified open-angle glaucoma, moderate stage|
|H40.1111||Primary open-angle glaucoma, right eye, mild stage|
|H40.1112||Primary open-angle glaucoma, right eye, moderate stage|
|H40.1121||Primary open-angle glaucoma, left eye, mild stage|
|H40.1122||Primary open-angle glaucoma, left eye, moderate stage|
|H40.1131||Primary open-angle glaucoma, bilateral, mild stage|
|H40.1132||Primary open-angle glaucoma, bilateral, moderate stage|
|H40.151||Residual stage of open-angle glaucoma, right eye|
|H40.152||Residual stage of open-angle glaucoma, left eye|
|H40.153||Residual stage of open-angle glaucoma, bilateral|
Medicare Reimbursement for Hydrus Microstent FAQs
Effective February 7, 2020
1. Does Medicare cover this procedure?
Yes, all Medicare Administrative Contractors (MACs) cover this procedure code when performed in accordance with the FDA approved directions for use, and in conjunction with medically necessary cataract surgery. Currently, these claims and the medical records are often subject to review by the MACs.
2. Do other third party payers cover the 0191T code?
Yes, many other payers cover this procedure. Whenever possible, prior authorization should be obtained before scheduling a procedure.
3. Is there separate Medicare reimbursement for the Hydrus Microstent device?
No. Medicare payment for the aqueous drainage device is included in the facility reimbursement for APC 5492. On UB-04 claim form, use HCPCS code C1783 with revenue code 278 to identify the prosthetic device. On a CMS-1500 claim form, do not report a code for the device. For other payers, check your contracts concerning prosthetic devices.
For more information about the Hydrus Microstent and Medicare reimbursement, download this FAQ fact sheet.
*As of February 7, 2020. The reimbursement information is provided by Corcoran Consulting Group based on publicly available information from CMS, the AMA, etc. The reader is strongly encouraged to review federal and state laws, regulations, code sets (including ICD-10), 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.