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.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare0100TCPTretinal prosthesisophthalmologysurgical implantartificial retinaretinitis pigmentosaambulatory surgeryhospital services

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`	Default/standard reporting	General reporting when no other modifier applies (use per payer rules).
`22`	Increased procedural services	When work, time, or complexity substantially exceeds typical for `0100T`.
`23`	Unusual anesthesia	Use if procedure performed under general anesthesia because local/regional not possible and payer accepts modifier.
`26`	Professional component	Use for the surgeon’s professional component when technical component billed separately by facility/lab.
`51`	Multiple procedures	When `0100T` is performed with other distinct surgical procedures during same session (subject to payer bundling rules).
`52`	Reduced services	When the procedure is partially reduced or not completed as planned but still performed.
`53`	Discontinued procedure	If the procedure is started but terminated due to patient condition or intraoperative complication before significant portion completed.
`62`	Two surgeons	When two surgeons work together as primary surgeons due to complexity of implantation.
`66`	Surgical team	When an organized surgical team is used for portions of the implantation requiring multiple specialists.
`78`	Return to OR for related procedure during postoperative period	For unplanned return to OR related to complications of the implant.
`80`	Assistant surgeon	When a qualified assistant surgeon provides assistance and payer requires modifier.
`81`	Minimum assistant surgeon	When a minimal assistant surgeon is used and payer accepts modifier.
`82`	Assistant (when not available)	When assistant surgeon is used and usual assistant not available; payer-dependent.
`TC`	Technical component	When the facility bills the technical component (device placement, supplies) separately from the surgeon’s professional service.
`QK`	Medical direction of two to four assistants	When physician directs multiple first assistants per CMS rules.

Taxonomy Code	Specialty	Notes
`207W00000X`	Ophthalmology	Retinal specialists (vitreoretinal surgeons) are primary providers for `0100T`.
`207W00000X`	Ophthalmology - Vitreoretinal Surgery	Subspecialty focus performing complex retinal implantations.
`2080P0207X`	Anesthesiology	Provides monitored anesthesia care or general anesthesia during implantation.
`333600000X`	Low Vision Specialist / Vision Rehabilitation	Postoperative device activation and rehabilitation specialists who train patients in device use.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`H35.52`	Retinitis pigmentosa	Primary hereditary retinal degeneration commonly leading to indications for epiretinal prosthesis.
`H35.30`	Degeneration of macula and posterior pole, unspecified	Advanced macular degeneration with severe photoreceptor loss may be considered when prosthesis candidates have central vision loss.
`H35.31`	Nonexudative age-related macular degeneration	End-stage dry AMD with geographic atrophy causing profound central vision loss; potential candidate in select cases.
`H35.89`	Other specified retinal disorders	Miscellaneous retinal dystrophies or degenerations considered for prosthetic intervention.
`H44.4`	Degeneration of globe	Advanced retinal structural loss where prosthesis may be considered in select clinical scenarios.
`H54.0`	Blindness, both eyes	Describes the functional status of candidates often evaluated for visual prosthesis to restore light perception.
`H54.4`	Blindness, one eye	Unilateral profound vision loss specification when device considered for the worse-seeing eye.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`67036`	Vitrectomy, pars plana; complex (e.g., for retinal detachment, membrane peeling)	A pars plana vitrectomy is typically performed immediately before epiretinal prosthesis placement to prepare the vitreous cavity and retina.
`67041`	Vitrectomy with peeling of epiretinal membrane	Epiretinal membrane peeling or membrane management may be required to allow electrode array apposition.
`66989`	Placement of intraocular lens prosthesis (if applicable)	If concurrent cataract extraction and intraocular lens placement are required prior to or during the implant surgery, this code describes lens implantation.
`92083`	Extended ophthalmoscopy with documentation and interpretation of imaging	Preoperative and postoperative extended retinal imaging and interpretation support device planning and follow-up.
`S9090`	Device-specific services (example code for device programming/support)	Postoperative device activation and programming by manufacturer-trained personnel are part of the clinical workflow; use appropriate supply/device or facility-specific codes per payer.