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.

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