YAG Laser in Ophthalmology and Other Selected Indications

Covered: Nd:YAG laser capsulotomy is covered for visually significant posterior capsular opacification after cataract extraction (unless performed prophylactically or at the time of surgery) when selection criteria are met—within 6 months only if BCVA is 20/50 or worse with confirmed PCO and functional impairment, or if BCVA is 20/40 or better with confirmed PCO plus fluctuating visual disability from glare/decreased contrast and functional interference—and is also covered at any time to improve visualization of the posterior pole (e.g., diabetic retinopathy, macular disease, retinal detachment, tumor diagnosis, optic nerve evaluation); Nd:YAG peripheral iridotomy is covered for primary angle closure/angle-closure glaucoma or before anterior-chamber IOL insertion. Excluded/experimental: Capsulotomy within 6 months that does not meet the above criteria is considered not covered/experimental and subject to medical necessity review, and Nd:YAG peripheral iridotomy for prevention of pigment dispersion glaucoma, Nd:YAG goniopuncture for failed trabeculectomy, and Nd:YAG vitreolysis for floaters are considered investigational.