HumanaCommercial Clinical Policy

Glaucoma Surgical Treatments Form

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Trabeculectomy

Indications

(262132) Is the patient's treatment related to glaucoma? 

Trabeculoplasty

Indications

(262133) Is the patient's treatment related to glaucoma? 

Iridotomy

Indications

(262134) Is the patient's treatment related to glaucoma? 

Iridectomy

Indications

(262135) Is the patient's treatment related to glaucoma? 

Iridoplasty

Indications

(262136) Is the patient's treatment related to glaucoma? 

YesNoN/A
YesNoN/A
YesNoN/A

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Effective Date

04/27/2023

Last Reviewed

NA

Original Document

  Reference



Glaucoma Surgical Treatments

Medical Coverage Policy

Effective Date:

04/27/2023

Revision Date:

04/27/2023

Review Date:

04/27/2023

Policy Number:

HUM-0475-029

Change Summary:

Updated Description, Coverage Determination, Coverage Limitations, Medical Alternatives, References

Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version. Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.

Disclaimer

Medical Alternatives

Description

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