Payer PolicyActive
CG-SURG-124 Viscocanalostomy
ANTHEM-CG-SURG-124
Anthem
Effective: January 30, 2025
Updated: December 30, 2025
Policy Summary
- Policy addresses: Viscocanalostomy, a nonpenetrating glaucoma surgery that unroofs and dilates Schlemm’s canal. - Coverage: Not medically necessary and therefore not covered for all indications, including treatment of primary open-angle glaucoma (POAG). - Key limitations: There are no covered indications under this policy; related claims may be reported with HCPCS/CPT code 66999.
Coverage Criteria Preview
Key requirements from the full policy
"Viscocanalostomy is considerednot medically necessaryfor all indications, including but not limited to the treatment of primary open-angle glaucoma (POAG)."
Sign up to see full coverage criteria, indications, and limitations.