Eyelid Thermal Pulsation
OTH903.025
This policy addresses eyelid thermal pulsation systems (e.g., LipiFlow, TearCare) and related tear‑film/meibomian gland imaging (e.g., LipiView, LipiScan) as treatments and diagnostic tools to heat and express meibomian glands for management of meibomian gland dysfunction (MGD) and evaporative dry eye in adult patients, including use to optimize corneal, cataract, or refractive surgery outcomes. Major limitations/requirements: the therapy and imaging are considered experimental/investigational/unproven for all indications, coverage is subject to the member’s benefit plan (this policy is inactive and not for current claims adjudication), and FDA‑cleared devices are intended for physician use in adults with most evidence limited to LipiFlow.
"Thermal pulsation as a treatment option for meibomian gland dysfunction (MGD)."
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