Effective March 1, 2026, Premera Blue Cross updated its Ophthalmology (MDC 02) coverage policy to designate a set of specific CPT codes as non‑covered experimental/investigational services. Non‑covered items include retinal prosthesis implantation and related intraocular electrode array procedures (e.g., 0100T, 0472T, 0473T), device interrogation/programming and visual training encounters, and new prosthesis implantation codes effective 01/01/2026. Advanced retinal imaging and remote OCT services such as the Notal Home OTC program codes (0604T–0606T) and retinal polarization scan (0469T) are also listed as non‑covered. Other emerging diagnostics (e.g., EyeBox 0615T) are included in the non‑covered list, signaling limited coverage for these novel ophthalmic technologies.
March 2026 Revision: Specific Ophthalmology CPTs Designated as Non‑Covered
This revision (effective 2026-03-01) to Premera Blue Cross policy 10.01.533_HMO lists specific CPT codes that are addressed as non-covered experimental/investigational services within the Ophthalmology (MDC 02) topic. The document adds or reiterates a number of technology/procedure-specific CPT codes related to retinal prosthesis systems, retinal imaging and remote OCT, device interrogation/programming, and intraocular prosthesis procedures. Notable codes included in this policy text are 0100T (placement of a subconjunctival retinal prosthesis receiver and pulse generator; Argus II), 0469T (retinal polarization scan), 0472T/0473T (device evaluation/interrogation of intraocular retinal electrode array), and a suite of remote optical coherence tomography retina codes 0604T–0606T (Notal Home OTC Program).
Retinal Prosthesis and Intraocular Electrode Procedures Included as Non‑Covered
The policy text enumerates procedural and technology codes across different ophthalmic domains indicating experimental/investigational status. Key device and procedural CPTs called out include: 0100T (subconjunctival retinal prosthesis implantation with vitrectomy), 0472T/ (in-person device evaluation/interrogation of intraocular retinal electrode arrays), and a code for implantation involving removal of crystalline lens or dislocated intraocular lens prosthesis (new code effective referenced in the document). These entries indicate that retinal prosthesis implantation, associated programming/evaluation services, and related intraocular prosthesis procedures are within the scope of the non-covered list in this ophthalmology MDC.
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.