CORRECT CODING – ARGUS® II RETINAL PROSTHESIS SYSTEM

Joint DME MAC Article

The Argus® II Retinal Prosthesis System (Second Sight Medical Products, Inc.) is an implanted retinal prosthesis.  FDA approval for marketing under this indication was granted on February 13, 2013.  According to the manufacturer, the Argus® II Retinal Prosthesis System consists of the implanted system, head mounted telemetry and video data collection system, video processing unit, video processing rechargeable batteries, and battery charger.

The device is surgically implanted.  This procedure is billed using a CPT code.  The implanted device is billed using HCPCS Level II code C1841 (RETINAL PROSTHESIS, INCLUDES ALL INTERNAL AND EXTERNAL COMPONENTS).  Services billed with a CPT code are not billable to the DME MACs as CPT codes are not within DME MAC jurisdiction.  Items provided as part of the service by the CPT code are considered incident to that service and are not separately billable to the DME MACs.

The Argus® II Retinal Prosthesis System does have external replacement parts such as batteries and the head mounted device.  These external replacement parts are not billable to the DME MAC even if the device is being used in the home.  The replacement parts must be billed to the A/B MAC. Medicare’s Benefit Policy Manual (Internet Only Publication 100-2) Chapter 20 Section 10 states, in relevant part:

[I]mplanted prosthetic devices, replacement parts, accessories and supplies for the implanted DME must be billed to the A/B MACs… and not the DME MAC.

Questions concerning HCPCS code classifications should be directed to the Pricing, Data Analysis and Coding (PDAC) contractor - Contact Center at (877) 735-1326 during the hours of 8:30 a.m. to 4:00 p.m. CT, Monday through Friday, or e-mail the PDAC by completing the DME PDAC Contact Form located on the PDAC website www.dmepdac.com/dmecs.

Published by Noridian as the PDAC, September 2016.  Republished by Palmetto GBA as the PDAC, February 2019