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 with concomitant aqueous drainage device insertion (CPT 66991 noncomplex; 66989 complex), goniotomy (CPT 65820), and unlisted anterior segment procedures (CPT 66999). Coverage limits include one billable unit per eye per date of service for device insertion codes (66991/66989 and 0449T/0671T) even if multiple devices are implanted, bundling restrictions (e.g., 65820 with 66174), and non-coverage of combinations of multiple MIGS procedures with cataract surgery; full medical record documentation supporting ICD-10 selection and medical necessity is required.

"Use CPT 66991 for noncomplex cataract removal with intraocular lens implant when a concomitant intraocular aqueous drainage device is inserted and LCD medical necessity criteria are met."