CG-SURG-114 Ophthalmic use of Nd:YAG Laser for Posterior Capsulotomy

Policy CG-SURG-114 addresses use of the Nd:YAG laser for posterior capsulotomy to treat posterior capsular opacification (PCO) after cataract surgery. It is medically necessary when PCO causes symptomatic visual impairment not correctable with a tolerable change in glasses/contacts, the vision loss interferes with daily activities (e.g., reading, driving, TV, vocational/recreational needs), other eye diseases are ruled out as the primary cause, and improvement in visual function is expected. It is not medically necessary when these criteria are not met.

"YAG laser posterior capsulotomy is consideredmedically necessaryforanyof the following:"

Sign up to see full coverage criteria, indications, and limitations.