Capsule Opacification Following Cataract Surgery: Discission and YAG Laser Capsulotomy

Nd:YAG anterior or posterior capsulotomy after cataract extraction is covered when it is medically necessary to remedy documented functional impairment from anterior or posterior capsule opacification, to prevent intraocular lens dislocation damage, or to permit posterior segment evaluation/treatment. Coverage requires documentation of decreased ability to perform activities of daily living, BCVA of 20/50 or worse (or a two-line decrease on consensual light or glare testing), exclusion of other primary ocular causes (unless physician documents capsule opacification as primary), physician concurrence of expected benefit, patient education, and a preoperative ophthalmologic evaluation; the procedure is generally limited to once per eye and cannot be performed concurrently with cataract removal surgery.

"Nd:YAG anterior or posterior capsulotomy after cataract extraction is reasonable and medically necessary to remedy functional impairment due to anterior or posterior capsule opacification, to preve..."