MED.00103 Automated Evacuation of Meibomian Gland

This policy addresses automated meibomian gland evacuation devices that apply localized heat with intermittent/graded pressure to the eyelids (e.g., LipiFlow) and associated tear film imaging for treating meibomian gland dysfunction. Anthem deems these services investigational/experimental and not medically necessary; therefore, they are not covered. There are no covered indications or exceptions under this policy, and tear film imaging performed in conjunction with these devices is also non-covered.

"The use of an automated evacuation device using heat and intermittent pressure, and associated tear film imaging, is consideredinvestigational and not medically necessaryfor the treatment of meibom..."

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