Summary
Effective January 1, 2027, this policy establishes that iris prosthesis devices (including CustomFlex Artificial Iris) are classified as investigational for all indications and therefore non-covered. Billing teams must ensure claims for CPT 66683 and HCPCS C1839 are processed as investigational/non-covered and members are informed of financial responsibility prior to service delivery.
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What to do
by Jan 1, 2027 · 4 steps
01Billing team should update billing system and claim processing workflows to flag CPT 66683 (Implantation of iris prosthesis) and HCPCS C1839 (Iris prosthesis) as investigational/non-covered services.
02Providers must obtain written acknowledgment from members before rendering these services informing them that iris prosthesis implantation is considered investigational and members are likely to be financially responsible for all costs.
03Verify claim denial reason codes are configured to communicate investigational status to providers and members.
04Flag any prior authorizations or approvals issued before this date for review to ensure no claims are processed under outdated coverage assumptions.
Codes mentioned
66683C1839
Original notice
Iris Prosthesis
beonbrand.getbynder.com · Always check the source before changing claims.