Billing and Coding: Micro-Invasive Glaucoma Surgery (MIGS)

This policy provides billing and coding guidance for Micro-Invasive Glaucoma Surgery (MIGS), specifying appropriate CPT codes for cataract removal with concomitant aqueous drainage device insertion (CPT 66991 for noncomplex, 66989 for complex), goniotomy (CPT 65820), and use of unlisted code 66999 for microgoniotomy/goniopuncture. It limits payment to one unit per eye per date of service for specified codes (66991, 66989, 0449T, 0671T), prohibits reporting certain procedure combinations (e.g., goniotomy with other angle surgeries or 65820 with 66174), and requires complete, legible medical record documentation supporting ICD-10 and CPT/HCPCS coding and medical necessity.

"Use CPT 66991 for noncomplex cataract removal with insertion of intraocular lens (IOL) implant and concomitant intraocular aqueous drainage device when LCD medically reasonable and necessary criter..."