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Independence has updated its coverage positions and covered diagnosis codes
in the policies on the treatment of glaucoma. The following policies were
posted as Notifications on November 1, 2017, and will go into effect January
30, 2018:
- Commercial: #11.05.16f: Aqueous Shunts, Microstents,
Viscocanalostomy, and Canaloplasty for the Treatment of Glaucoma
- Medicare Advantage: #MA11.105d: Aqueous Shunts, Microstents,
Viscocanalostomy, and Canaloplasty for the Treatment of Glaucoma
Revised coverage positions
As part of the update, coverage positions are being revised to:
- expand covered surgical approach (i.e., external or internal) used for the
insertion of aqueous shunts;
- address medical necessity for the number of microstents inserted.
Updated covered diagnosis codes
The covered diagnosis codes for aqueous shunts and microstents are being
updated as follows:
- For insertion of aqueous shunts (CPT® codes 0449T, 66179,
66183, or 66184): Claims must include a diagnosis code for glaucoma listed
in Attachment A of these policies.
- For implantation of microstents (CPT codes 0191T or 0474T): Claims
must include a diagnosis code for cataract and a diagnosis code for mild or
moderate open-angle glaucoma listed in Attachment A of these policies.
For more information
To view the Notifications for these policies, visit our Medical Policy Portal. Select Accept and Go to Medical
Policy Online, and then select Commercial or Medicare
Advantage under Active Notifications.
CPT Copyright 2016 American Medical Association. All
rights reserved. CPT® is a registered trademark of the American
Medical Association.
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