YAG Capsulotomy

YAG laser capsulotomy is covered for posterior capsular opacification after cataract extraction when PCO causes functional visual impairment (e.g., Snellen visual acuity ≤20/30, glare, or decreased contrast) as determined by the treating ophthalmologist. Procedures are generally performed ≥90 days post‑cataract extraction; YAG within 3 months is not covered except when justified by specific early indications (uncorrectable posterior capsular plaque, capsular block, or posterior capsule contraction with IOL displacement) with appropriate documentation.

"Posterior capsular opacification (PCO) after cataract extraction causing functional visual impairment, as determined by the treating ophthalmologist."

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