Micro-Invasive Glaucoma Surgery (MIGS)

FDA-approved glaucoma aqueous drainage devices used within their indications are covered: (1) single intraocular insertions into the trabecular meshwork or supraciliary space when performed with cataract surgery for adults with mild-to-moderate open-angle glaucoma on ocular hypotensive medication, and (2) single subconjunctival insertions as standalone treatment for refractory glaucoma after prior procedure failure and/or uncontrolled IOP (mean diurnal medicated IOP ≥ 20 mmHg) on maximally tolerated medical therapy. Non-FDA-approved or recalled devices, device use outside FDA indications, suprachoroidal insertions, additional insertions beyond the specified single-insertion limits, and routine combined goniotomy or multiple-insertor use are not covered. Claims must document device FDA status, clinical indications (including cataract when applicable), prior procedure failures or IOP measurements and medication history, and provider qualifications; services are subject to post-payment audit and focused medical review.