CommercialCoverageHigh impact
Viscocanalostomy and Canaloplasty (CPB 0435, reviewed 2026-02-12)
Aetna·Ophthalmology·Medical Policy
Effective date
Feb 12, 2026
We identified it
Aug 18, 2026
Summary
Aetna's updated CPB 0435 clarifies coverage for canaloplasty procedures in glaucoma treatment. Canaloplasty alone (CPT 66174, 66175) remains covered for primary open-angle glaucoma, normal-tension glaucoma, and pseudo-exfoliation glaucoma. However, multiple combination procedures—including canaloplasty with trabeculotomy, viscodilation systems (OMNI, STREAMLINE, Trab360), cataract surgery combinations, and newer techniques (GATT/ABiC, Ologen implants)—are classified as experimental/investigational and NOT covered. Billing teams must immediately update claim edits to deny these combination procedures.
Action Required
IMMEDIATELY: Billing team must update claim submission rules in billing software to deny the following combinations when billed together for glaucoma treatment: (1) CPT 66174/66175 + CPT 65820 (canaloplasty with trabeculotomy/goniotomy); (2) CPT 66174/66175 + cataract surgery codes (66982, 66983, 66984, 66987, 66988, 66989, 66991); (3) Any Trab360, OMNI, STREAMLINE, GATT/ABiC, or Ologen implant combinations. Update claim editing logic to automatically deny these combinations with denial reason: 'Experimental/investigational procedure—not covered per Aetna CPB 0435.' Train providers that ONLY standalone canaloplasty (CPT 66174 or 66175) is covered for POAG, normal-tension glaucoma, and pseudo-exfoliation glaucoma (ICD-10: H40.1110-H40.1194, H40.1210-H40.1294, H40.1410-H40.1494). Do NOT cover canaloplasty for corticosteroid-induced glaucoma, uveitic glaucoma, or pigmentary glaucoma. Flag all combination procedure claims for manual review until automated rules are tested. Communicate policy change to ophthalmology providers within 5 business days.