Clinical Scorecard: Coding & Reimbursement: Navigating New Coverage Challenges for MIGS

At a Glance

Key Highlights

• MIGS is not considered a first-line treatment for mild-moderate glaucoma.
• Single MIGS procedure coverage allowed during cataract surgery; multiple MIGS procedures in one session are non-covered.
• Documentation of patient compliance with ocular hypotensive medications is essential for coverage.
• MACs have established policies that may differ from commercial payers.
• Medical necessity must be clearly documented to support MIGS recommendations.

Guideline-Based Recommendations

Diagnosis

• Establish medical necessity for MIGS based on patient-specific factors.

Management

• MIGS should be considered when maximum tolerated medical therapy fails.

Monitoring & Follow-up

• Regular documentation of patient compliance with prescribed medications.

Risks

• Claims involving multiple MIGS procedures are likely to be denied.

Patient & Prescribing Data

Patients with glaucoma, particularly those on ocular hypotensive medications.

Proper documentation is crucial to demonstrate medical necessity for MIGS.

Clinical Best Practices

• Customize documentation to reflect each patient's unique situation.
• Understand both MAC and commercial payer policies for MIGS.

References

• American Academy of Ophthalmology (AAO) Guidelines
• Glaukos iStent Inject Instructions for Use
• Alcon Hydrus Microstent Instructions for Use