CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Retinal Prostheses — Coverage Criteria

This policy governs coverage of retinal prosthesis devices and related procedures for members of Blue Cross Blue Shield - Rhode Island; it states the payer's coverage stance for commercial and Medicare Advantage products.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyRetinal Prostheses — Coverage Criteria

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionDo not submit claims for retinal prostheses and listed codes; these are considered not medically necessary and may be denied.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

not coveredcoverage stance for retinal prostheses

Argus II discontinuedFDA-cleared device availability

n≈30primary study size

listedcodes not covered

Coverage Determination

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Procedure, Device, and Supply Codes

Procedure codes (listed)CPTNot Covered

0100T

Placement of a subconjunctival retinal prosthesis receiver and pulse generator, and implantation of intra-ocular retinal electrode array, with vitrectomy

Device evaluation / programmingCPTNot Covered

0472T	Device evaluation, interrogation, and initial programming of intraocular retinal electrode array (eg, retinal prosthesis), in person, with iterative adjustment of the implantable device to test functionality, select permanent programmed values with analysis, including visual training, with review and report by a qualified health care professional
0473T	Device evaluation and interrogation of intraocular retinal electrode array (eg, retinal prosthesis), in person, including reprogramming and visual training, with review and report by qualified health care professional

HCPCS / Supply codesHCPCSNot Covered

L8608

Miscellaneous external component; supply or accessory for use with the Argus II Retinal Prosthesis System

Provider Billing and Documentation Actions

Prior Authorization

Prior authorization is not applicable for retinal prosthesis services under this policy.

Denial Risk

Denial Risk — Retinal Prostheses

Claims for retinal prostheses and the listed procedure and supply codes may be denied as not covered or not medically necessary. Providers should review member benefits and eligibility prior to submission.

Affected codes include: 0100T, 0472T, 0473T, and L8608

Documentation Required

Documentation Expectations

Maintain complete clinical documentation demonstrating medical necessity, indication, device details, FDA status, pre‑implantation assessments, informed consent, post‑implant follow-up, device programming/training, and outcomes. Documentation should support why the service meets coverage criteria or, if not covered, evidence that the member was informed of noncoverage.

Clinical and Device Background

Retinal prostheses are devices intended to restore vision by transmitting external images to an implanted array of electrodes or to subretinal light sensors, thereby attempting to replace lost photoreceptor function. These systems typically involve an implanted electrode array and external components (for example, systems cleared via the Humanitarian Use Device pathway such as the Argus II), and rely on device programming and visual training to produce functional effects.

Definitions

Definition — retinal prosthesis

TermRetinal prosthesis

DefinitionA device that transmits external images to an array of electrodes or light sensors placed in the epiretinal or subretinal space to restore photoreceptor function.

Clinical targetsIntended to restore vision in conditions such as retinitis pigmentosa, hereditary retinal degeneration, and some forms of age-related macular degeneration.

Definition — Humanitarian Use Device (HUD) clearance pathway

TermHumanitarian Use Device (HUD) clearance

DefinitionFDA clearance pathway for devices intended to benefit fewer than 4,000 people in the U.S. per year.

ExampleArgus II Retinal Prosthesis System — cleared in 2013 via the HUD pathway (Second Sight); discontinued in 2019.