CJ Wolf
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The American Medical Association’s (AMA) CPT® Manual undergoes many changes on an annual basis and many of those changes become effective January 1st each year. 2025 is no exception.
One new code for 2025 is for implanting a prosthesis of the iris of the eye. The iris, or the colored part of the eye, is a smooth muscle that opens or closes the pupil, which is the hole at the center of the eye that allows light to enter (see diagram). The iris constricts the pupil in response to bright light and dilates the pupil in response to dim light.
[This image can be accessed for free at openstax.org. OpenStax is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0)]
Prior to January 1, 2025, there were Category III codes for iris procedures (see Category III codes 0616T-0618T). Sometimes Category III codes are changed to Category I codes, which are what most people are familiar with or call ‘regular’ CPT® codes.
According to the AMA’s CPT® Manual, Category III codes are “…temporary codes for emerging technology, services, procedures, and service paradigms. Category III codes allow data collection for these services/procedures…If a Category III code is available, this code must be reported instead of a Category I unlisted code.”
Not all Category III codes become Category I codes. Many become archived after five years of Category III code status.
In the case of the iris codes,0616T-0618T have been deleted for 2025 and a new Category I code 66683 has been created.
The code description for 66683 is “Implantation of iris prosthesis, including suture fixation and repair or removal of iris, when performed.”
Iris prosthesis implantation is performed when a patient has suffered damage to the iris or when they have a condition like aniridia (i.e., absence of the iris). When the iris is damaged, there can be visual impairments.
Third party payors typically have their own policies on whether or not this procedure is covered and if so, under what circumstances it would be covered. Medicare’s national physician fee schedule payment rate (i.e., unadjusted for locality) as of January 1, 2025, is $748.82 with a work RVU assignment of 10.67.
Other third-party payors sometimes consider iris prosthesis surgery as investigational. This often means coverage is based on specific qualifying circumstances. Some examples include:
HealthyBlueNC:
https://provider.healthybluenc.com/dam/medpolicies/healthybluenc/active/policies/mp_pw_e000641.html
This policy states “the use of implanted artificial iris devices are considered investigational and not medically necessary for all indications, including as a treatment of congenital or traumatic aniridia.”
Aetna:
https://www.aetna.com/cpb/medical/data/700_799/0713.html
This policy states “Aetna considers the following interventions experimental, investigational, or unproven because the effectiveness of these approaches has not been established:
Artificial iris devices (e.g., the CustomFlex Artificial Iris) for anterior segment reconstruction, and the treatment of aniridia, post-operative or traumatic aphakia, and other iris defects.”
Hospitals:
Under Medicare’s OPPS, code 66683 maps to APC 5496 which has a status indicator of J1 and payment rate of $16,416.44. The HCPCS code for the iris prosthesis itself is C1839 which has a status indicator of N under OPPS.
The company VEO Ophthalmics makes an artificial iris called the CUSTOMFLEX®. More information on this particular device can be found at their website: https://www.veo-ophthalmics.com/customflex-artificialiris
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