Summary & Overview
CPT 0100T: Retinal Prosthesis (Artificial Retina) Implantation
CPT code 0100T denotes the surgical implantation of a retinal prosthesis (artificial retina) to restore basic light perception in patients with severe retinal degeneration. The procedure places a silicone-and-platinum device and an electrode array in the epiretinal space to transmit external images and reestablish the distinction between presence and absence of light. Nationally, this code represents a specialized, high-cost interventional approach for select patients with conditions such as retinitis pigmentosa and certain hereditary retinal disorders and forms of age-related macular degeneration.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and service setting, and coverage-relevant considerations for major national payers. The publication summarizes expected use cases for 0100T, highlights typical sites of service (hospital operating rooms and ambulatory surgical centers), and provides an outline of what to expect regarding coding classification and claim submission elements.
This resource is intended for billing managers, clinical coders, and policy analysts seeking a national view of the clinical purpose and administrative framing of CPT code 0100T. Data not available in the input will be noted where applicable.
Billing Code Overview
CPT code 0100T describes the surgical implantation of a retinal prosthesis (artificial retina). The procedure involves attaching a silicone-and-platinum prosthetic device to the patient’s retina and placing an array of electrodes in the epiretinal space to restore basic light perception by reestablishing the distinction between light and dark.
Service type: Surgical implantation of a retinal prosthesis
Typical site of service: Hospital operating room or ambulatory surgical center, with postoperative follow-up in ophthalmology clinics.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with advanced hereditary retinal degeneration (for example, late-stage retinitis pigmentosa) who has severe outer retinal photoreceptor loss with preserved inner retinal cells and optic nerve function. The patient presents with profound central and/or peripheral vision loss and has been evaluated by a retinal specialist and low-vision rehabilitation team. Preoperative evaluation includes full ophthalmic exam, optical coherence tomography (OCT), fluorescein angiography as indicated, visual field testing, and neuro-ophthalmic assessment to confirm candidacy. Systemic evaluation ensures surgical fitness under monitored anesthesia care or general anesthesia.
During the clinical workflow the surgeon obtains informed consent describing the investigational or FDA-approved retinal prosthesis device, reviews imaging and electrophysiology, and schedules implantation. In the operating room the provider performs a pars plana vitrectomy, prepares the epiretinal surface, and attaches the silicone–platinum electrode array to the retina as described in 0100T. Postoperative care includes topical and/or systemic antibiotics and steroids, positioning as directed, serial retinal exams, OCT surveillance for device position and retinal integrity, device activation and programming by the manufacturer-trained team, and structured low-vision rehabilitation sessions to train the patient in use of restored light perception.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 |