Glaucoma Surgical Treatments – Commercial and Individual Exchange Medical Policyopen_in_new

UnitedHealthcare covers pediatric goniotomy/trabeculotomy (≤18 years), specific MIGS/microstents (ab interno canaloplasty, combined canaloplasty+trabeculotomy, goniotomy/trabeculotomy, iStent/iStent inject/Hydrus) only when performed with cataract surgery in adults ≥19 with mild–moderate open‑angle glaucoma on ocular hypotensive medication, glaucoma drainage devices (e.g., XEN, Ex‑PRESS, Baerveldt, Ahmed) for refractory glaucoma after failed or inappropriate medical/surgical therapy, and standard laser procedures (trabeculoplasty, iridotomy/iridectomy, iridoplasty, ciliary body destruction); other FDA‑approved laser procedures and procedures outside the listed indications (including standalone MIGS not specified) are considered unproven/not medically necessary. Key requirements include documentation of age and diagnosis, presence of visually significant cataract and current ocular hypotensive therapy for combined MIGS, expectation of meaningful IOP or medication reduction (e.g., ≥20% IOP or ≥1 medication), evidence of prior treatment failure for drainage devices, operative/pre‑ and post‑op data, and verification of member‑specific benefits (FDA approval alone does not ensure coverage).