CG-SURG-125 Canaloplasty

This policy addresses canaloplasty (CPT 66174, 66175), a surgical procedure to lower intraocular pressure by dilating Schlemm’s canal. It is considered medically necessary only for the treatment of primary open-angle glaucoma (POAG) and not medically necessary for all other indications. Coverage is therefore limited to POAG; other glaucoma types or uses are not covered.

"Canaloplasty is consideredmedically necessaryfor the treatment of primary open-angle glaucoma (POAG)."

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