CMS Pub. 100-04, ch. 4, § 61.2.2

Effective CY 2024, the OCE will return to providers claims that report a procedure code

assigned to APC 5496 – Level 6 Intraocular Procedures – but do not report the correct

device code that must be implanted during the procedure. The device code must correctly

reflect the type of device that was implanted during the procedure. The table below

displays the procedures assigned to the Level 6 Intraocular Procedures APC as well as the

appropriate device code that must be present on the claim for that procedure. Hospitals

may not bypass this edit by reporting modifier “CG.”

APC

5496

CPT

Codes

Long Descriptor

Device

HCPCS

Code to

Report with

CPT code

Long Descriptor

0308T

Insertion of ocular telescope

prosthesis including removal of

crystalline lens or intraocular

lens prosthesis

C1840 Lens, intraocular

(telescopic)

0616T

Insertion of iris prosthesis,

including suture fixation and

repair or removal of iris, when

performed; without removal of

crystalline lens or intraocular

lens, without insertion of

intraocular lens

C1839 Iris prosthesis

0617T

Insertion of iris prosthesis,

including suture fixation and

repair or removal of iris, when

performed; with removal of

crystalline lens and insertion of

intraocular lens

C1839 Iris prosthesis

0618T

Insertion of iris prosthesis,

including suture fixation and

repair or removal of iris, when

performed; with secondary

intraocular lens placement or

intraocular lens exchange

C1839 Iris prosthesis

This edit does not apply if the provider reports one of the following modifiers with the

procedure code:

52 – Reduced Services;

73 – Discontinued outpatient procedure prior to anesthesia administration; and

74 – Discontinued outpatient procedure after anesthesia administration.

If the claim is returned to the provider for failure to pass the edit, the provider will need

to modify the claim by correcting the device code (only if the device code to be reported

accurately describes the device that was implanted), or, by correcting the procedure code

on the claim before resubmission.