Predictika · Interventional glaucoma claims

An AI agent's glaucoma procedure claim, checked before it goes out

An AI agent prepares a billing claim for a glaucoma procedure that uses a Glaukos device or drug: the device, the setting and payer, the procedure, device and drug codes, units, the diagnosis and stage, and the payment it expects. Before it goes out, the agent sends it to Predictika, which checks it against a declarative model of the public Glaukos billing and coding guide and returns a verdict, every reason and the figures it computed. This is a consistency check against the guide, not coding advice.

Scope: Claims for Glaukos iStent infinite, iStent inject W, iDose TR and the iAccess Precision Blade, as described in the public 2026 Glaukos Interventional Glaucoma Billing and Coding Guide: procedure, device and drug codes, units, diagnosis and stage, modifiers, revenue codes and the published Medicare payment rates. See everything this validator covers

This validator models one claim at a time for these four Glaukos products, based on the public Glaukos billing and coding guide, and handles any claim that uses them, not just the scenarios shown below.

  • Procedure and device codes — the stents are billed with CPT 0671T (standalone), 66989 or 66991 (with cataract surgery) and may carry HCPCS C1783 or L8612 with units that can match the stents deployed; iDose TR is billed with CPT 0660T and HCPCS J7355 in 75 units; the iAccess Precision Blade goniotomy with CPT 65820; 0671T is never reported with 66989 or 66991, and the guide lists an eye modifier for 66989.
  • Diagnosis and indication — open-angle glaucoma codes need a seventh stage character from 0 to 4; iStent inject W is contraindicated in angle-closure glaucoma (and iStent infinite where the angle has not been surgically opened); iStent inject W is indicated with cataract surgery, for mild to moderate disease and for two stents; diagnoses outside an indication go to a person.
  • Facility claim details — revenue code 0636 for the drug on a hospital outpatient claim, the revenue code 278 the guide lists for the device codes, the NDC for iDose TR, and prior authorization for Category III codes with Medicare Advantage and commercial payers.
  • Published payment — the 2026 national unadjusted Medicare payment for each code in an ambulatory surgical center, a hospital outpatient department or the physician office, as printed in the guide; the payment the claim states must equal it.

Any claim for these products that touches these rules is in scope — not only the scenarios pictured here. Not covered: Glaukos prices (none are published; the dollar figures are Medicare national rates from the guide), other Glaukos products such as Photrexa and iLink, payer-specific policies, geographic or sequestration adjustments, and coding advice: the guide says it is informational and that providers decide which codes to use.

The AI sales agentBuilds the claim from the conversation and says it is ready.
Predictika validatorChecks every rule at once and returns the verdict, each finding, and the computed figures.

7 scenarios in 3 groups · each group runs from the agent’s first attempt to the outcome · click one to switch

What the agent proposes

The AI sales agent says

Illustrative agent statement. The validator receives the structured request below.

Proposing agent: AI sales agent (scripted)

Before sending, the agent must call Recorded run

Predictika validator


      

        
        
        
      

      
Waiting for the call.

      
    

  

  
  

    
Where rules-based CPQ gets it wrong
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Our assessment of what a typical rules-based CPQ (product rules, price rules and validation rules, as in Salesforce CPQ) does with the same cases. It is a judgment about effort and reliability, not a claim that nothing can be built.

    
What the validator caughtTypical rules-based CPQPredictika
A procedure or drug code that fits one device and not another (stent, iDose TR, goniotomy)Only with care
A product rule per device listing its allowed codes; each new device or code is another rule, and a wrong pairing is caught only if the rule was written.		Device, procedure code, drug code and units arrive in one request and every pairing is checked on every call.
A code that must never accompany another (0671T with 66989 or 66991)Only with care
An exclusion across two code lines, in either order, that has to be remembered for each pair.		Both codes are fields in the request and the exclusion is checked whichever line they are on.
Revenue code, units and NDC that depend on the device, setting and claim formOnly with workarounds
Several dependent rules on three fields from different lines; easy to apply to the wrong form or setting.		Device, setting, form, units, revenue code and NDC are checked together.
Diagnosis detail and indication limits by device (stage character, mild to moderate, two stents)Only with workarounds
Clinical limits from the instructions for use rarely live in pricing or quoting rules, so they are checked by hand or not at all.		The diagnosis, stage and device are checked against the published indication and anything outside it goes to a person.
Payment the claim states, by code and settingOnly with care
A table of codes by setting that the stated amount must be compared with.		The stated payment is a field in the request, compared with the published rate for that code and setting on every call.
Every problem returned in one answerOnly with workarounds
Rules tend to fire as the claim is saved or a step is completed, so a person often fixes one error and meets the next.		All findings come back together, whatever order the choices arrived in.

  

  

    
What this validator catches: findings from its test cases
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Every rule is checked on every call, in any order the choices arrive; one problem never hides another. Blocking findings stop the quote; approval findings need a person to sign off; everything else is computed.

    
1The claim bills the standalone code 0671T, but iStent inject W is indicated for use in conjunction with cataract surgery.
2The guide lists CPT 0671T, 66989 and 66991 for the trabecular micro-bypass stents; the claim bills a code for a different procedure.
3Implantation of iDose TR is reported with CPT 0660T; the claim bills a different primary code.
4The iAccess Precision Blade goniotomy is reported with CPT 65820; the claim bills a different primary code.
5CPT 0671T must not be reported together with 66989 or 66991.
6HCPCS J7355 is the travoprost intracameral implant drug code and cannot be reported for a stent.
7The iDose TR drug is reported with HCPCS J7355; the claim has a different or no HCPCS code.
8The iDose TR drug is billed in 75 units of J7355; the claim bills 1 unit(s).
9Open-angle glaucoma diagnosis codes need a seventh character for the stage, from 0 to 4; the claim has none or one outside that range.
10IStent infinite is contraindicated in eyes with angle-closure glaucoma where the angle has not been surgically opened; a person should confirm the angle status.
11IStent inject W is contraindicated in eyes with angle-closure glaucoma.
12The iDose TR indication is open-angle glaucoma or ocular hypertension; an angle-closure diagnosis is outside that indication, so a person should confirm it.
13The stents are indicated for primary open-angle glaucoma; this diagnosis is outside that indication (the iStent inject W precautions name pseudoexfoliative and pigmentary glaucoma), so a person should confirm it.
14The guide lists modifier -LT (left) or -RT (right) for CPT 66989; the claim has none, so a person should confirm.
15On a hospital outpatient claim CMS requires revenue code 0636 when billing a drug.
16The guide lists revenue code 278 for HCPCS C1783 and L8612; the facility claim shows a different or no revenue code, so a person should confirm.
17The claim states a Medicare national unadjusted payment of 4,000 dollars for this code in this setting; the guide lists 4,387 dollars.
18The iStent inject W indication is mild to moderate glaucoma (stage 1 or 2); a person should confirm stage 3.
19The iStent inject W indication is mild to moderate glaucoma (stage 1 or 2); a person should confirm stage 4.
20The safety and effectiveness of iStent inject W are not established for implanting more or less than two stents; the claim has 3 stent(s).
21The safety and effectiveness of iStent inject W are not established for implanting more or less than two stents; the claim has 1 stent(s).
22The service units on a stent device code may correspond to the number of stents deployed; the claim has 2 unit(s) for 3 stent(s).
23The guide lists no national payment for this code in this setting because Category III codes are carrier priced; a person should confirm the expected payment.
24The guide highly recommends prior authorization from Medicare Advantage and commercial payers for the Category III code 0671T and notes that some plans require it for iDose TR; the claim shows none.

  

  

    
Scenarios and results
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The recorded result of the validator for each scenario on this page: the request the AI agent sent, the verdict, and every finding, in the order they appear above.

    
1. iStent inject W with cataract surgery: Stent claim billed with the standalone code and the cataract code

    
The agent's request. Please prepare a claim for a procedure with the Glaukos iStent inject W at an ambulatory surgical center, billed to Medicare fee-for-service on a CMS-1500 form. Bill CPT 0671T with CPT 66991, for a diagnosis of primary open-angle glaucoma, stage 1. Include HCPCS C1783 for 2 units. 2 stents were implanted. The claim states a Medicare national unadjusted payment of $4,387 for this code in this setting. It is ready to send.

    
Verdict: Blocked.

    
    
      
  • iStent inject W billed as a standalone procedure. The claim bills the standalone code 0671T, but iStent inject W is indicated for use in conjunction with cataract surgery.
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  • 0671T reported with a cataract code. CPT 0671T must not be reported together with 66989 or 66991.
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2. iStent inject W with cataract surgery: The agent resubmits after fixing the errors

    
The agent's request. Please prepare a claim for a procedure with the Glaukos iStent inject W at an ambulatory surgical center, billed to Medicare fee-for-service on a CMS-1500 form. Bill CPT 66991, for a diagnosis of primary open-angle glaucoma, stage 1. Include HCPCS C1783 for 2 units. 2 stents were implanted. The claim states a Medicare national unadjusted payment of $4,015 for this code in this setting. It is ready to send.

    
Verdict: Allowed.

    
    
      
  • Payment summary. The guide lists a Medicare national unadjusted payment of 4,015 dollars for this code in this setting.
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3. iDose TR at a hospital outpatient department: Hospital outpatient claim for an iDose TR implant under Medicare Advantage

    
The agent's request. Please prepare a claim for a procedure with the Glaukos iDose TR at a hospital outpatient department, billed to Medicare Advantage on a CMS-1450 form. Bill CPT 0660T, for a diagnosis of primary open-angle glaucoma. Include HCPCS J7355 for 1 unit. Use revenue code 278. The claim states a Medicare national unadjusted payment of $4,223 for this code in this setting. It is ready to send.

    
Verdict: Blocked.

    
    
      
  • iDose TR billed in the wrong number of units. The iDose TR drug is billed in 75 units of J7355; the claim bills 1 unit(s).
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  • Glaucoma stage character missing or invalid. Open-angle glaucoma diagnosis codes need a seventh character for the stage, from 0 to 4; the claim has none or one outside that range.
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  • Revenue code 0636 required for the drug. On a hospital outpatient claim CMS requires revenue code 0636 when billing a drug.
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  • Prior authorization recommended. The guide highly recommends prior authorization from Medicare Advantage and commercial payers for the Category III code 0671T and notes that some plans require it for iDose TR; the claim shows none.
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  • NDC missing for iDose TR. Payers often require the NDC on an iDose TR claim (25357-100-01, or 25357-0100-01 in 11 digits); the claim has none.
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4. iDose TR at a hospital outpatient department: The agent resubmits after fixing the errors

    
The agent's request. Please prepare a claim for a procedure with the Glaukos iDose TR at a hospital outpatient department, billed to Medicare Advantage on a CMS-1450 form. Bill CPT 0660T, for a diagnosis of primary open-angle glaucoma, stage 2. Include HCPCS J7355 for 75 units. Use revenue code 0636. The claim states a Medicare national unadjusted payment of $4,223 for this code in this setting. It is ready to send.

    
Verdict: Needs approval.

    
    
      
  • Prior authorization recommended. The guide highly recommends prior authorization from Medicare Advantage and commercial payers for the Category III code 0671T and notes that some plans require it for iDose TR; the claim shows none.
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  • NDC missing for iDose TR. Payers often require the NDC on an iDose TR claim (25357-100-01, or 25357-0100-01 in 11 digits); the claim has none.
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  • Payment summary. The guide lists a Medicare national unadjusted payment of 4,223 dollars for this code in this setting.
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5. iDose TR at a hospital outpatient department: The agent resubmits after fixing the errors

    
The agent's request. Please prepare a claim for a procedure with the Glaukos iDose TR at a hospital outpatient department, billed to Medicare Advantage on a CMS-1450 form. Bill CPT 0660T, for a diagnosis of primary open-angle glaucoma, stage 2. Include HCPCS J7355 for 75 units. Use revenue code 0636. The NDC is 25357-0100-01. Prior authorization is on file. The claim states a Medicare national unadjusted payment of $4,223 for this code in this setting. It is ready to send.

    
Verdict: Allowed.

    
    
      
  • Payment summary. The guide lists a Medicare national unadjusted payment of 4,223 dollars for this code in this setting.
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6. iStent infinite with complex cataract surgery: Stent claim with the complex cataract code

    
The agent's request. Please prepare a claim for a procedure with the Glaukos iStent infinite at an ambulatory surgical center, billed to a commercial payer on a CMS-1500 form. Bill CPT 66989, for a diagnosis of primary open-angle glaucoma. Include HCPCS C1783 for 3 units. 3 stents were implanted. The claim states a Medicare national unadjusted payment of $3,974 for this code in this setting. It is ready to send.

    
Verdict: Blocked.

    
    
      
  • Glaucoma stage character missing or invalid. Open-angle glaucoma diagnosis codes need a seventh character for the stage, from 0 to 4; the claim has none or one outside that range.
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  • Eye modifier not on 66989. The guide lists modifier -LT (left) or -RT (right) for CPT 66989; the claim has none, so a person should confirm.
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7. iStent infinite with complex cataract surgery: The agent resubmits after fixing the errors

    
The agent's request. Please prepare a claim for a procedure with the Glaukos iStent infinite at an ambulatory surgical center, billed to a commercial payer on a CMS-1500 form. Bill CPT 66989 and modifier -RT, for a diagnosis of primary open-angle glaucoma, stage 2. Include HCPCS C1783 for 3 units. 3 stents were implanted. The claim states a Medicare national unadjusted payment of $3,974 for this code in this setting. It is ready to send.

    
Verdict: Allowed.

    
    
      
  • Payment summary. The guide lists a Medicare national unadjusted payment of 3,974 dollars for this code in this setting.
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Narration transcript
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The text of the narrated walkthrough, step by step.

    
    
      
  1. Welcome to a demo of Predictika's Validator. An AI agent prepares a billing claim for a glaucoma procedure that uses a Glaukos device or drug: the device, the setting and payer, the procedure, and more. Before it goes out, the agent sends it to Predictika, which checks it against a declarative model of the public Glaukos billing and coding guide and returns a verdict, every reason and the figures it computed. This is a consistency check against the guide, not coding advice.
    2. 
      
  2. I will start with the first request by the agent.
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  3. The agent says. Please prepare a claim for a procedure with the Glaukos iDose TR at a hospital outpatient department, billed to Medicare Advantage on a CMS-1450 form. Bill CPT 0660T, for a diagnosis of primary open-angle glaucoma. The rest of the request is on screen. The claim states a Medicare national unadjusted payment of $4,223 for this code in this setting.
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  4. Before it goes out, the agent calls the validator.
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  5. Blocked, with three findings and two approvals, all in one answer. The iDose TR drug is billed in 75 units of J7355; the claim bills 1 unit(s). Open-angle glaucoma diagnosis codes need a seventh character for the stage, from 0 to 4; the claim has none or one outside that range. On a hospital outpatient claim CMS requires revenue code 0636 when billing a drug.
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  6. The validator returned three blocking findings and two approvals in one answer. A check that reads one field at a time would pass most of this; it shows only when the choices in the quote are checked against each other.
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  7. What this shows: for revenue code, units and NDC that depend on the device, setting and claim form, a rules-based CPQ can do this only with workarounds.
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  8. Now the agent resubmits.
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  9. The corrected request. It changes the units billed to 75 and the revenue code to 0636. It sets the stage to 2 seventh character.
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  10. It calls the validator again.
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  11. Not blocked, but held for a person.
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  12. The three blocking findings are cleared; two approvals remain for a person: prior authorization recommended and NDC missing for iDose TR.
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  13. The agent resubmits once more.
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  14. The revised request. It sets the NDC to 25357-0100-01 and the payer authorization on file to yes.
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  15. It calls the validator once more.
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  16. This time the validator clears it.
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  17. Both earlier findings are cleared, and the validator's total, $4,223, matches the quote.
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  18. Five problems caught in one call, fixed in two passes, and a clean quote. That is the value of Predictika's validator: catching mistakes before they reach the customer. Now you can try the other scenarios yourself.
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