Glaucoma Surgical Procedures - (0035)

Cigna covers implantation of listed aqueous shunts (Ahmed, Baerveldt, ExPRESS, Krupin, Molteno) for refractory glaucoma and considers single XEN45, iStent Infinite (≥18 years), and canaloplasty (≥18 years) medically necessary when conventional medical and surgical treatments have failed, are not tolerated, or are contraindicated (with specific indications required for XEN45). Transciliary fistulization and viscocanalostomy are excluded as experimental/investigational, multiple XEN implants are not supported, and coverage requires use of approved CPT/HCPCS codes plus documentation (prior treatment failure/intolerance/contraindication, age when applicable, operative notes and clinical data) to substantiate medical necessity.

"Aqueous shunts/aqueous drainage devices (CPT/HCPCS Codes 66179, 66183) are considered medically necessary for refractory glaucoma when there is failure, intolerance or contraindication to conventio..."