LCD/NCD Portal

L29311

 

YAG LASER CAPSULOTOMY

 

02/02/2009

 

Indications and Limitations of Coverage and/or Medical Necessity

• Medicare will consider the Nd:Yag laser capsulotomy medically necessary and reasonable if the following criteria are met:

o The patient complains of symptoms such as blurred vision, visual distortion and/or glare resulting in reduced ability or inability to carry out activities of daily living due to decreased visual acuity or an increase in glare, particularly under bright light conditions, and/or conditions of night driving.

o The eye examination confirms the diagnosis of posterior capsular opacification and excludes other ocular causes of functional impairment by one of the following methods:

 The eye examination should demonstrate decreased light transmission (visual acuity < 20/30 or < 20/25 if the procedure is performed to assist in the diagnosis and treatment of retinal detachment) after other causes of loss of acuity have been ruled out, or

 Additional testing must demonstrate

• 1) contrast sensitivity testing resulting in a decreased visual acuity by two (2) lines or

• 2) A decrease of two (2) lines of visual acuity in the glare tester.

o This procedure should not be routinely scheduled after cataract surgery and rarely would it be expected to see this procedure performed within four months following cataract surgery.

 However, if a patient develops a posterior capsular opacification within four months following cataract surgery, Yag laser capsulotomy will be considered medically reasonable and necessary when the documentation demonstrates the following:

• the patient is experiencing symptoms of blurred vision,

• visual distortion, and/or glare with associated functional impairments;

• Decreased light transmission (visual acuity < 20/30; and/or contrast sensitivity testing or glare testing resulting in a decreased visual acuity by two (2) lines.

o Occasionally, a Yag laser capsulotomy may also be performed

 to assist in the diagnosis and treatment of retinal detachment;

 to assist in the diagnosis and treatment of macular disease;

 to assist in the diagnosis and treatment of diabetic retinopathy;

 to evaluate the optic nerve head; or

 To diagnose posterior pole tumors.

o Generally, the YAG laser capsulotomy is expected to be performed only once per eye per lifetime of a beneficiary.

 

CPT/HCPCS Codes

 

66821 DISCISSION OF SECONDARY MEMBRANOUS CATARACT (OPACIFIED POSTERIOR LENS CAPSULE AND/OR ANTERIOR HYALOID); LASER SURGERY (EG, YAG LASER) (1 OR MORE STAGES)

 

 

ICD-9 Codes that Support Medical Necessity

 

 

366.50 AFTER-CATARACT UNSPECIFIED

366.51 SOEMMERING'S RING

366.53 AFTER-CATARACT OBSCURING VISION

 

Documentation Requirements

• Documentation such as the patient’s medical record should demonstrate very clearly why Yag laser capsulotomy was performed. This should include the results of a visual acuity test and/or a glare test

• If procedure code 66821 is billed within four months of cataract surgery, documentation must be submitted with the claim to determine medical necessity.

 

Treatment Logic

• The neodymium: YAG (Nd: YAG) laser is used to create posterior capsulotomies for posterior capsule opacification.

o Posterior capsule opacification generally occurs following cataract surgery.

• Desired outcomes of use of the Nd: YAG laser are an increase in visual acuity and/or improvement in glare and contrast sensitivity.

 

Sources of Information and Basis for Decision

 

American Academy of Ophthalmology (AAO), Anterior Segment Panel. Cataract in the adult eye. American Academy of Ophthalmology (AAO). 2001, 62 p. Retrieved October 24, 2005 from the National Guideline Clearinghouse at www.guideline.gov (002313).

 

Buehl, W. (2005). Association between intensity of posterior capsule opacification and visual acuity. J Cataract Refract Surg, 31(3), 543-547.

 

02/02/2009

The official local coverage determination (LCD) is the version on the Medicare coverage database at www.cms.gov/medicare-coverage-database/.

 

AMA CPT / ADA CDT Copyright Statement

CPT codes, descriptions and other data only are copyright 2011 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Clauses Apply. Current Dental Terminology, (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. © 2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.

 

CMS LCD L29311 YAG Laser Capsulotomy