Criteria
Insertion of ab externo aqueous shunts approved by the U.S. Food and Drug Administration (FDA) may be considered medically necessary as a method to reduce IOP in individuals with glaucoma where medical therapy has failed to adequately control IOP.
Insertion of ab interno aqueous stents approved by the FDA may be considered medically necessary as a method to reduce IOP in individuals with glaucoma where medical therapy has failed to adequately control intraocular pressure.
Use of ab externo or ab interno aqueous shunt(s) for all other conditions when IOP is adequately controlled by medications is considered experimental/investigational and therefore non-covered, because the safety and/or effectiveness of this service cannot be established by the available published peer-reviewed literature.
Procedure Codes