Medicare AdvantageCoverageMedium impact
MA11.105j, Aqueous Shunts, Microstents, Viscocanalostomy, and Canaloplasty for the Treatment of Glaucoma
Independence Blue Cross·NJ · Ophthalmology·Medical Policy
We identified it
Jun 19, 2026
Summary
Independence Blue Cross has reissued Medicare Advantage policy MA11.105j (now MA11.105l) regarding aqueous shunts, microstents, viscocanalostomy, and canaloplasty for glaucoma treatment. The policy maintains existing coverage criteria for FDA-approved aqueous shunts and stents under specified conditions, with CPT codes 66174 and 66175 updated effective 01/01/2023. The policy now applies to New Jersey Medicare Advantage lines of business as of 01/01/2024.
Action Required
REQUIREMENTS:
- Billing team: Verify that billing software correctly maps aqueous shunt and stent procedures to CPT codes 66179, 66180, 66183, 66184, 66185 and HCPCS codes C1783 and L8612.
- Providers: Ensure documentation includes required clinical criteria (e.g., failed medical therapy, IOP levels, glaucoma severity classification using the mild/moderate damage definitions) for all aqueous shunt and stent claims.
- New Jersey providers: Confirm this policy applies to your Medicare Advantage lines of business effective 01/01/2024. Review prior authorizations for any grandfathered claims.
- Billing team: Flag claims for aqueous stents (iStent, iStent inject, XEN, Hydrus) placed with cataract surgery in mild-to-moderate open-angle glaucoma as medically necessary and ensure they are not bundled with cataract surgery codes without proper modifier documentation.
- All staff: Review contraindication criteria for iStent inject (angle closure glaucoma, traumatic/malignant/uveitic/neovascular glaucoma, elevated episcleral venous pressure conditions) and ensure providers document ruling out these conditions before authorization.
- Compliance: Verify that claims for multiple ab externo aqueous shunts per eye are denied appropriately, as these remain experimental/investigational.