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Blue Cross & Blue Shield of MississippiAll Plans · Coverage · Medical Policy · OphthalmologyMedium impact

Aqueous Shunts and Stents for Glaucoma

Effective date
Not stated in the notice
Identified
Jun 20, 2026

Summary

FDA-approved ab externo aqueous shunts and FDA-approved ab interno aqueous stents are considered medically necessary to reduce intraocular pressure in individuals with glaucoma where medical therapy has failed to adequately control intraocular pressure. Implantation of 1 or 2 FDA-approved ab interno stents with cataract surgery may be considered medically necessary in individuals with mild-to-moderate open-angle glaucoma treated with ocular hypotensive medication. Ab externo shunts and ab interno stents used for all other conditions, including glaucoma where intraocular pressure is adequately controlled by medications, are considered investigational.

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What to do

Action · 3 steps
01Billing team: Confirm that claims for CPT 0253T, 0449T, 0450T, 0474T, 0671T, 66175, 66179, 66183, 66184, 66989, 66991 and HCPCS L8612 match a medically necessary indication in the Policy section before submitting them, because the source states these codes are only medically necessary when performed according to that section.
02Review claims for ab externo shunts or ab interno stents used for any other condition, including glaucoma where intraocular pressure is adequately controlled by medications, against this policy before submitting them, since the policy considers them investigational.
03For Federal Employee Program members, FDA-approved devices may be assessed only on the basis of medical necessity, per the policy exceptions.

Codes mentioned

661756617966183661846698966991L8612

Original notice

Aqueous Shunts and Stents for Glaucoma
bcbsms.com · Always check the source before changing claims.
View original ↗

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Related policy hubs

Blue Cross & Blue Shield of Mississippi policiesOphthalmologyCode 66175Code 66179Code 66183Code 66184Code 66989Code 66991Code L8612

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