HCPCS code C1842 – Retinal prosthesis add-on

Key takeaways

HCPCS Code C1842 reported the Argus II retinal prosthesis as an add-on to C1841, the primary retinal prosthesis code.

CMS terminated C1842 with a last valid date of service of December 31, 2022, and its HCPCS file names no replacement code.

CMS created C1842 in 2017 to fix an ambulatory surgical center claims issue and told hospital outpatient departments not to report it.

Under OPPS, C1842 carried status indicator E1 back to January 1, 2017, so Medicare did not pay it on hospital outpatient claims.

Today the code matters only for reopenings, appeals, audits and records requests on 2017 to 2022 dates of service.

HCPCS Code C1842: definition and code description

HCPCS Code C1842 is a deleted Level II C-code for a retinal prosthesis, including all internal and external components, reported as an add-on to C1841. CMS calls it the Argus retinal prosthesis add-on code, after the Argus II Retinal Prosthesis System it was built for.

The official descriptor reads: Retinal prosthesis, includes all internal and external components; add-on to C1841. An add-on code never stands alone. C1842 only appeared on a claim alongside C1841, which described the same device, and the implantation procedure, CPT 0100T.

C-codes sit in the HCPCS Level II code set and normally serve the Medicare Outpatient Prospective Payment System (OPPS). C1842 was an exception, because CMS built it for ambulatory surgical center (ASC) claims rather than hospital claims.

C1842 code details at a glance

Every fact in this table comes from CMS transmittals and the CMS HCPCS quarterly files.

What the Argus II retinal prosthesis is used for

The Argus II treats severe to profound retinitis pigmentosa, an inherited retinal disease that destroys the light-sensing cells of the retina. The FDA approved it in 2013 under humanitarian device exemption H110002.

The approved patient group is narrow. It covers adults aged 25 or older with bare light perception or no light perception in both eyes, who once had useful form vision. The surgeon implants the device in one eye, usually the worse-seeing one.

The system pairs an implanted electrode array on the retina with external parts the patient wears, including glasses carrying a small camera. That split explains the descriptor wording, which bundles internal and external components into one code.

On the diagnosis side, retinitis pigmentosa codes to ICD-10-CM H35.52, pigmentary retinal dystrophy. That is the diagnosis a reviewer expects to see next to the C1841 and C1842 lines on an Argus II claim.

Is C1842 still valid? Code status and the 2023 deletion

No. The CMS HCPCS file records a termination date of December 31, 2022, for C1842, with the deletion effective January 1, 2023. C1841 carries the same termination date. The October 2026 HCPCS quarterly file still shows both codes with that end date.

CMS lists no cross-reference code for either one. The HCPCS file uses that field to point a deleted code at its successor, and it is blank here. No successor exists because the device left the market, so there is no current code to move these services to.

The withdrawal came first. In its July 2022 ASC update, CMS stated that the Argus II device was no longer available in the marketplace. It added that neither hospital outpatient providers nor ASCs were still performing the implantation.

Why CMS created C1842 and who could report it

CMS announced C1842 in Transmittal 3685, dated December 22, 2016. It took effect on January 1, 2017, with status indicator N. CMS said the code existed to resolve a claims processing issue for ASCs.

The same transmittal stated that hospital outpatient departments should not report C1842 on institutional claims. The code missed the CY 2017 annual HCPCS file. Medicare contractors added it by hand, following the January 2017 code editor update.

Transmittal 3728, dated March 3, 2017, then changed the OPPS status indicator from N to E1. E1 means Medicare does not pay the item on any outpatient bill type. CMS made that change retroactive to January 1, 2017.

Together, the two transmittals split the code by setting. An ASC claim reported C1841 and C1842 together, alongside the 0100T procedure line. A hospital outpatient claim left C1842 off, as Transmittal 3685 directed. The chart below maps how a C1842 line was treated by setting and date of service.

Medicare ASC payment history for C1842

Medicare paid C1842 through the ASC payment system, not OPPS. Its ASC payment indicator was J7 by April 2022. J7 marks a pass-through device paid separately when it is integral to a surgical procedure on the ASC list. The Medicare contractor sets its price.

From July 1, 2022, CMS moved 0100T, C1841 and C1842 to payment indicator K5. K5 covers items for which pricing information and claims data are not available, and contractors deny those lines.

Because each Medicare contractor priced J7 lines itself, CMS never published one national rate for C1842. Treat any single dollar figure for the code with caution, and check the remittance or the contractor record for the claim in question.

How C1842 relates to C1841 and C1840

C1841 and C1842 describe the same device, so the codes are a pair rather than alternatives. C1840 sits next to them numerically but describes a different ophthalmic implant.

If an operative note describes a telescopic lens implant, the device code is C1840. A retinal prosthesis never codes to C1840.

Handling C1842 on older claims, appeals and audits

Medicare requires claims within 12 months of the date of service, so original C1842 claims are long past the filing window. The code now surfaces in reopenings, appeals, payer audits and records requests on 2017 to 2022 ASC services.

Sound medical billing compliance on those files rests on five elements in the record:

• Device identity: the operative note names the Argus II Retinal Prosthesis System, not a generic implant.
• Operated eye: the note states which eye received the implant, since the device goes into one eye only.
• The primary code: C1841 appears on the same claim, because C1842 is an add-on and cannot stand alone.
• The procedure line: CPT 0100T reports the implantation and matches the date of service in the note.
• The diagnosis: the claim carries a retinitis pigmentosa diagnosis, H35.52, supported by the documented visual loss.

CMS instructions for C1842 name no required modifier. One modifier can still appear on these files. GX means a notice of liability was issued voluntarily under payer policy, so it only belongs where the ASC gave that notice.

Denial codes you may see on C1842 lines

The remittance advice explains each denied line with a claim adjustment reason code (CARC). These are the codes most likely to appear against C1842, with their official meaning.

A K5 line denied on or after July 1, 2022, reflects CMS policy rather than a coding error. Strong denial management starts with that distinction, because an appeal cannot change a payment indicator.

Commercial payer and Medicare Advantage coverage

Commercial plans and Medicare Advantage plans set their own retinal prosthesis policies, and some required prior authorization for the implant. Several have since been retired or updated to note the deleted codes.

For any 2017 to 2022 claim, pull the archived policy version that applied on the date of service. A current policy will often say only that the codes were deleted, which does not settle an older claim.

How Pabau keeps device claim records ready for review

An audit or appeal on a retired code turns on finding years-old paperwork quickly. Practices often split the operative note, consent forms and remittance across separate systems, so one request becomes a search through each of them.

Pabau, the practice management platform we build, keeps the clinical record, signed forms and invoices on one patient file. In the US, its claims management submits claims through Claim.MD and tracks their status, using data already on that record.

Pabau does not choose codes for you. Your coders still select every code. What changes is the retrieval, because the device note, the claim and its outcome sit together when a reviewer asks for them.

Keep device claims and records in one place

Pabau keeps clinical notes, signed forms and claim status on one patient record, so your team can answer an audit or appeal quickly.

Book a demo

Conclusion

Treat C1842 as a closed code. Use it only to read, correct or defend 2017 to 2022 ASC claims, and always beside C1841 and 0100T. For any later service, no Medicare code replaces it.

The work that remains is evidence. A file that ties the Argus II device, the operated eye and the diagnosis to one claim holds up. A file split across systems is far harder to defend. Book a demo to see how Pabau keeps device notes and claim records together for review.

Continue your research

Billing a different ophthalmic implant? HCPCS Code C1839 covers the iris prosthesis code and the procedure codes it is billed with.

Coding a telescopic lens instead? HCPCS Code C1840 explains the telescopic intraocular lens code that sits next to C1842.

Decoding a remittance line? Denial codes in medical billing maps common reason codes to their causes and fixes.

Want fewer resubmissions? What is a clean claim shows what a payer needs to process a claim on the first pass.

Frequently asked questions