E156

PDF page 769 / Y3

REPLACEMENT
    Corneal transplant
# E121 - penetrating .........................................................................      6     740.00    7
# E951   - with artificial prosthesis .............................................. add                   52.40
# E122 - lamellar...............................................................................    6     590.00    7
# E124 Limbal stem cell transplant .....................................................            6     740.00    8
# E123 Division of iris to cornea and/or angle.....................................                       161.75    6
      Payment rules:
      1.E117 is not eligible for payment with E124.
         2.E123 is not eligible for payment with E133, E132, E114, E115, E156 or E157
         3.E121 is eligible for payment for performing DSEK (Descemet's Stripping Endothelial
           Keratoplasty), DMEK (Descemet's Membrane Endothelial Keratoplasty) and DALK (Deep
           Anterior Lamellar Keratoplasty)
         4.E123 is only eligible for payment in addition to E121 under one of the following
           circumstances:
            a.Previous corneal transplantation,
            b.Post-operative corneal melt,
            c.Corneal perforation from trauma or infection, or
            d.Congenital conditions with iris corneal adhesions only when the iris adhesion is
               documented preoperatively and documented in the operative record.
         5.E117 is not eligible for payment with E121.

PDF page 770 / Y4

# E212 Bleb repair with conjunctival pull-down...................................                          6         210.00          6
# E213 Bleb repair with conjunctival, scleral or mucous membrane
          graft ....................................................................................       6         262.50          6
# E133 Extraocular glaucoma procedures ..........................................                          6         182.75          6
# E135 Ciliary body re-attachment......................................................                    6         505.45          7
# E156 Intraocular suturing of iris/pupillary defect .............................. 6                                350.00          7
# E157 Placement and/or suturing of iris prosthetic device with or
          without suturing of iris/pupillary defect ............................... 6                                550.00          7
      Payment rules:
      1.E950 is not eligible for payment in conjunction with E156 or E157.
         2.E156 is not eligible for payment for repair of iris tears resulting from cataract extraction.

Master, record 982. Record Layout PDF, page 1.

E15620260401999999990000350000000000774600000000000000000111720000001117200

Auxiliary master fields are preserved as raw scaled values. The linked layout calls them zero-filled, but this edition contains non-zero values. They are not presented as final dollar fees or PDF units.