Payer PolicyActive
Viscocanalostomy and Canaloplasty
AETNA-CPB-0435
Aetna
Effective: June 19, 2023
Updated: December 6, 2025
created · Dec 2, 2025
Policy Summary
Canaloplasty is covered as medically necessary for primary open‑angle glaucoma (including normal‑tension) and pseudoexfoliation glaucoma (CPT 66174/66175 and specified ICD‑10 codes) only when selection criteria are met; conversely, canaloplasty for other indications, all viscocanalostomy procedures (including phacoviscocanalostomy), and specific combinations (OMNI or GATT/ABiC with phaco, phaco+viscocanalostomy with Ologen) are experimental/investigational and not covered.
Coverage Criteria Preview
Key requirements from the full policy
"Non-randomized study with no control group."
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