CMSLocal Coverage Determination (LCD)

CMS YAG Capsulotomy Form


YAG Capsulotomy

Indications

(407556) Is the YAG Capsulotomy being performed for opacification of the posterior capsule? 
(407557) Has it been at least 90 days since the cataract extraction? 
(407558) Is the YAG Capsulotomy indicated due to visual loss and/or symptoms of glare with visual acuity 20/30 or worse? 
(407559) Is the YAG Capsulotomy indicated due to symptoms of decreased contrast? 
(407560) Is the YAG Capsulotomy indicated due to the amount of posterior capsular opacification? 

YesNoN/A
YesNoN/A
YesNoN/A

Sign up to see the rest of the questions

Unlock the remaining questions and the full coverage workflow.

Sign up for free
Effective Date

03/10/2022

Last Reviewed

03/03/2022

Original Document

  Reference



Background for this Policy

Summary Of Evidence

N/A

Analysis of Evidence

N/A

Neodymium-doped Yttrium Aluminum Garnet (YAG) laser capsulotomies are performed in cases of opacification of the posterior capsule, generally no less than 90 days following cataract extraction. YAG performed less than 90 days following cataract extraction should meet both the indications and limitations of this Local Coverage Determination (LCD). The percentage of patients having this procedure varies greatly among ophthalmologists. Diagnosis of functional visual impairment due to capsular opacification is based on clinical judgment regarding 1 or more of the following:

  1. Visual loss and/or symptom of glare (visual acuity 20/30 or worse under Snellen conditions, using contrast sensitivity, or simulated glare testing);
  2. Symptoms of decreased contrast;
  3. Amount of posterior capsular opacification or;
  4. Other possible causes of decreased vision following cataract surgery.

Limitations

This procedure will not be covered within 3 months post cataract surgery unless justified by 1 of the following indications:

  1. Posterior capsular plaque/opacity which cannot be safely removed during primary phacoemulsification cataract procedure
  2. Capsular block during which cataract remnants and fluid become trapped within the lens capsule and addressed with YAG laser posterior capsulotomy
  3. Contraction of the posterior capsule with displacement of the intraocular lens.