CommercialCoverageMedium impact
Aqueous Drainage Devices (Stents and Shunts) for Glaucoma 9.01.18
Excellus BlueCross BlueShield·Ophthalmology·Eyes (Ophthalmology)
Effective date
Jan 22, 2026
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield has established new medical necessity criteria for aqueous drainage devices (stents and shunts) used in glaucoma treatment, effective January 22, 2026. The policy defines specific coverage criteria including failed medical therapy or medication intolerance for general devices, and mild-to-moderate open-angle glaucoma with current medication treatment for micro-stents during cataract surgery.
Action Required
Before January 22, 2026: Ophthalmology billing staff must update prior authorization processes to ensure glaucoma drainage device procedures meet new medical necessity criteria. Document that either medical therapy has failed to control intraocular pressure OR medications are not tolerated. For micro-stent procedures with cataract surgery, verify patient has mild-to-moderate open-angle glaucoma and is currently on ocular hypotensive medications. Update encounter forms to include required documentation elements.