CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Retinal Prosthesis Coverage Policy

This policy governs coverage and medical necessity determinations for retinal prosthesis devices and related procedures for Blue Cross Blue Shield - Rhode Island members, distinguishing Medicare Advantage and Commercial products.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyRetinal Prosthesis Coverage Policy

Policy CodePolicy N/A

Change TypeNo material change

Effective DateSep 1, 2023

Next Review DateN/A

Key ActionDo not submit claims for retinal prosthesis codes listed as not covered or not medically necessary; verify member benefits and eligibility before proceeding.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Not coveredMedicare Advantage stance

Not medically necessaryCommercial Products stance

0100T, 0472T, 0473T, C1841, C1842, L8608Not covered codes

30 patientsStudy size (Argus II)

Coverage Determinations

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.

Coverage summary

Coverage determinations by product:

Medicare Advantage coverage: Retinal prostheses are not covered for Medicare Advantage Plans because the evidence is insufficient to determine the effects of the technology on health outcomes.

See policy statement

Commercial Products coverage: Retinal prostheses are considered not medically necessary for Commercial Products because the evidence is insufficient to determine the effects of the technology on health outcomes.

See policy statement

Codes considered not covered / not medically necessary: The following codes are considered not covered for Medicare Advantage Plans and not medically necessary for Commercial Products: 0100T; 0472T; 0473T; C1841; C1842; L8608.

See coding list

The following procedure and device codes are identified as not covered / not medically necessary for Medicare Advantage Plans and Commercial Products: 0100T (Placement of a subconjunctival retinal prosthesis receiver and pulse generator, and implantation of intra-ocular retinal electrode array, with vitrectomy), 0472T (Device evaluation, interrogation, and initial programming of intraocular retinal electrode array), 0473T (Device evaluation and interrogation of intraocular retinal electrode array, including reprogramming and visual training), C1841 (Retinal prosthesis, includes all internal and external components; code deleted 1/01/2023), C1842 (Retinal prosthesis add-on; code deleted 1/01/2023), and L8608 (Miscellaneous external component, supply or accessory for use with the Argus II Retinal Prosthesis System).

Relevant Procedure and Device Codes

Not covered / Not medically necessary codesmixedNot Covered

0100T	Placement of a subconjunctival retinal prosthesis receiver and pulse generator, and implantation of intra-ocular retinal electrode array, with vitrectomy
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 optimal 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, when performed, with review and report by a qualified health care professional
C1841	Retinal prosthesis, includes all internal and external components (Code deleted 1/01/2023)
C1842	Retinal prosthesis, includes all internal and external components; add-on to C1841 (Code deleted 1/01/2023)
L8608	Miscellaneous external component, supply or accessory for use with the Argus II Retinal Prosthesis System

Provider Responsibilities and Billing Actions

Note

Prior Authorization

Prior authorization is not applicable for this policy. Codes listed below are handled per the coverage determination (see denial risk).

Prior authorization: Not applicable

Documentation Required

Provider and Member Agreement

Verify member eligibility and benefits prior to scheduling services. Confirm coverage, applicable member cost sharing, and whether services are benefit exclusions under the subscriber agreement.

Check member-specific benefits and eligibility with the provider call center or insurer portal prior to delivering services.

Denial Risk

Denial Risk for Listed Codes

Claims for the listed retinal prosthesis procedure and device codes are considered not covered for Medicare Advantage plans and not medically necessary for Commercial products. Billing for these codes may result in claim denial; do not balance-bill members unless you have obtained written informed consent acknowledging member responsibility when services are non-covered.

Affected codes: 0100T, 0472T, 0473T, C1841 (deleted 01/01/2023), C1842 (deleted 01/01/2023), L8608
Action: Do not bill as covered services. Verify benefits and obtain written informed consent before providing non-covered services if member agrees to self-pay.

Documentation Required

Documentation and Billing Guidance

Documentation: maintain thorough clinical records supporting medical necessity and any informed-consent forms if proceeding with non-covered services at the member's request. Providers may not charge members for services determined not medically necessary unless the member has been informed and provided written agreement to accept financial responsibility.

Keep documentation of benefit verification and written member agreement if applicable.
Follow participation agreement and state/federal billing rules when seeking payment from members.

Clinical Background

Retinal prostheses are implantable systems designed to restore some visual function by electrically stimulating remaining retinal cells. Typical procedures include placement of a receiver and pulse generator and implantation of an intraocular retinal electrode array (for example, as described in code 0100T), followed by device evaluation, programming, and training visits (for example, codes 0472T and 0473T). Multiple device designs exist, and some codes reference specific systems or components (for example, L8608 for an external component of the Argus II system). Current clinical evidence is judged insufficient to establish improved health outcomes for these technologies.

Key Definitions

Retinal prosthesis — definitions and device types

DefinitionAn implantable device (epiretinal, subretinal, or suprachoroidal) that transmits external images or light to an electrode array or photodiode array to stimulate remaining retinal cells and potentially restore functional vision.

Epiretinal devicesImplanted on the surface of the retina; receive external images (often via camera and glasses) and stimulate retinal ganglion cells through an electrode array (examples: systems with 25–100+ electrodes).

Subretinal devicesImplanted beneath the retina (subretinal space); may use multi‑photodiode arrays that sense incident light directly and stimulate inner retinal cells without external image processing (eg, Alpha IMS/PRIMA approaches).

Suprachoroidal devicesPlaced in a scleral pocket or suprachoroidal space with electrodes positioned farther from the retina (eg, Microelectrode‑STS); may have lower resolution but potentially safer surgical approach since electrodes do not touch the retina.

Signal transduction mechanismsEither electrode arrays that deliver electrical stimulation to retinal neurons (epiretinal/subretinal) or light‑sensitive photodiode arrays that convert light to electrical signals (subretinal), with external cameras and transmitters used in many designs.