Management of Meibomian Glands (CPB 0797, reviewed 2025-11-19)
Effective date
Not stated in the notice
Identified
Aug 18, 2026
Summary
Aetna considers several devices and treatments for meibomian gland dysfunction and dry eye experimental, investigational or unproven because their effectiveness has not been established. These include the LipiFlow System, LipiView tear film imaging, in-vivo confocal microscopy, the LipiScan near-infrared dual imaging system, and treatments such as intense pulsed light, intra-ductal meibomian gland probing, the RedTouch laser, the TearCare System, autologous platelet-rich plasma drops, androgens and umbilical cord-derived mesenchymal stem cell eye drops. CPT codes 0207T, 0330T, 0507T, 0552T, 0563T, 68040, 68810 and 68811 and HCPCS codes G0460 and P9020 are listed as not covered for the listed indications, as are the listed ICD-10 codes for hordeolum, chalazion, blepharitis, meibomian gland dysfunction, dry eye syndrome and epiphora. Expression of conjunctival follicles is considered experimental, investigational, unproven and not medically necessary for chalazion, dry eyes, hordeolum and meibomian gland dysfunction.
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01Billing team: CPT codes 0207T, 0330T, 0507T, 0552T, 0563T, 68040, 68810 and 68811 are not covered for the indications listed in the policy.
02HCPCS codes G0460 and P9020 are not covered for the indications listed in the policy.
03The ICD-10 codes listed in the policy are not covered for the indications listed in the policy.
04The policy considers experimental, investigational or unproven the devices and treatments it lists, including the LipiFlow System, the TearCare System, intense pulsed light and the RedTouch laser.
05Expression of conjunctival follicles is not medically necessary for chalazion, dry eyes, hordeolum or meibomian gland dysfunction.
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