CG-SURG-40 Cataract Removal Surgery for Adults

This policy addresses cataract removal surgery for adults. It is covered when there is a documented cataract causing symptomatic visual impairment not correctable with a tolerable change in glasses or contacts; the vision loss interferes with daily activities (e.g., reading, watching TV, driving, work/recreation); other eye diseases have been ruled out as the primary cause (e.g., macular degeneration, diabetic retinopathy); and surgery is expected to improve visual function. It is not covered when these criteria are not met, when glasses or visual aids provide satisfactory functional vision, or when visual function is not compromised by the cataract.

"Cataract removal surgery in adults is consideredmedically necessaryforanyof the following:"

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