Micro-Invasive Glaucoma Surgery (MIGS)

Medically necessary coverage for MIGS is limited to one approved stent device per eye: a trabecular aqueous stent performed with cataract surgery for adults with mild-to-moderate open-angle glaucoma on ocular hypotensive medication, or a subconjunctival or trabecular stent as a standalone procedure for refractory glaucoma (prior filtering/cilioablative failure or mean diurnal medicated IOP ≥20 mmHg on maximally tolerated therapy). MIGS is not first-line for mild-moderate glaucoma; combination of MIGS with an aqueous shunt or multiple MIGS modalities at the same time in the same eye is non-covered. Providers must be appropriately trained/credentialed and XEN45 insertion requires an ophthalmologist experienced in trabeculectomy and bleb management.

"One trabecular aqueous stent device per eye is covered for adults with mild or moderate open-angle glaucoma (OAG) and coexisting cataract when the patient is currently being treated with an ocular ..."