Tag intelligence

Ophthalmology reimbursement alerts

Reimbursement alerts filtered by specialty and region tags for faster analysis across coding, compliance, and revenue integrity.

Critical tag risk

Overview

31 alerts match the tag Ophthalmology. Review high-value policy alerts and the underlying claims guidance that matters.

Quick stats

Alert count

31

Distinct policy codes

31

Average signal score

68

Related codes

Signal breakdown

31 shown · 31 total in platform

Risk: Critical
1

Critical

3%

24

High

77%

6

Routine

19%

0

Low

1%

New this month

+2

alerts added in last 30 days

Effective soon

no upcoming deadlines

FDA Approval: LUMVOA (VELIGROTUG-VVZE) — Type 1 - New Molecular Entity

Policy FDA-BLA761530Ophthalmology

Critical

LUMVOA (veligrotug) was approved on June 26, 2026 as a new molecular entity administered intravenously, placing it squarely in the Part B billing pathway as a provider-administered injectable. As a br

FDA Approval: FLUORESCITE (FLUORESCEIN SODIUM) — Type 5 - New Formulation or New Manufacturer

Policy FDA-NDA021980Ophthalmology

High

Fluorescite (Fluorescein Sodium) is approved as an injectable drug, which suggests it will qualify for a J-code assignment for Medicare billing. As an injectable and likely high-cost therapy, it may b

FDA Approval: RANLUSPEC (RANIBIZUMAB-HKDZ) — Type 2 - New Active Ingredient

Policy FDA-BLA761480Ophthalmology

Routine

The billing pathway for RANLUSPEC cannot be determined until the FDA label publishes. Billing teams should verify against the label for the final route of administration and associated billing details

LCD L34760: Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI) — WPS

Policy LCD-L34760Ophthalmology

High

The new LCD on SCODI by WPS introduces specific guidelines that could impact the billing processes for ophthalmic diagnostic imaging services. Practices may need to adjust their coding and ensure comp

LCD L38026: Corneal Hysteresis — Palmetto GBA

Policy LCD-L38026Ophthalmology

High

The new LCD on Corneal Hysteresis will likely streamline the billing process for ophthalmology services, ensuring that necessary tests are covered under Medicare. Providers should prepare for potentia

LCD L34061: Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI) — CGS

Policy LCD-L34061Ophthalmology

High

The implementation of the new LCD for SCODI may impact billing procedures and reimbursement rates for ophthalmic diagnostic imaging. Practices should review the updated guidelines closely to ensure co

LCD L37015: Visual Electrophysiology Testing — WPS

Policy LCD-L37015Ophthalmology

High

The new Local Coverage Determination (LCD) for Visual Electrophysiology Testing issued by WPS is expected to impact billing practices significantly starting from August 28, 2025. This may lead to clai

LCD L34203: Cataract Surgery in Adults — Noridian

Policy LCD-L34203Ophthalmology

High

The LCD for cataract surgery in adults emphasizes the specific criteria that must be met for coverage under Medicare. Providers should ensure proper documentation to mitigate denials and ensure compli

LCD L37027: Cataract Surgery in Adults — Noridian

Policy LCD-L37027Ophthalmology

High

The new LCD on Cataract Surgery in Adults will significantly affect billing practices by establishing clear guidelines for coverage and reimbursement. Providers should familiarize themselves with the

LCD L34394: Visual Fields Testing — CGS

Policy LCD-L34394Ophthalmology

High

The addition of Visual Fields Testing to LCD requires billing team review. This could lead to supports compliance with updated rates for eligible tests, improving practice revenue and

LCD L34194: Blepharoplasty, Eyelid Surgery, and Brow Lift — Noridian

Policy LCD-L34194Ophthalmology

High

The new LCD for blepharoplasty and related procedures may affect reimbursement rates and eligibility for coverage under Medicare. Providers should review the specific requirements to ensure compliance

LCD L38299: Micro-Invasive Glaucoma Surgery (MIGS) — Noridian

Policy LCD-L38299Ophthalmology

High

The upcoming LCD for Micro-Invasive Glaucoma Surgery (MIGS) will likely influence billing practices for ophthalmology services. Providers need to familiarize themselves with the new guidelines to ensu

LCD L36286: Blepharoplasty, Eyelid Surgery, and Brow Lift — Noridian

Policy LCD-L36286Ophthalmology

High

The implementation of LCD for Blepharoplasty and related procedures may significantly affect billing practices by establishing more stringent criteria for reimbursement. Providers must ensure document

LCD L38301: Micro-Invasive Glaucoma Surgery (MIGS) — Noridian

Policy LCD-L38301Ophthalmology

High

The new LCD for Micro-Invasive Glaucoma Surgery (MIGS) by Noridian is set to take effect on November 17, 2024. This will influence billing practices for ophthalmology practices, necessitating updates

LCD L33946: Capsule Opacification Following Cataract Surgery: Discission and YAG Laser Capsulotomy — CGS

Policy LCD-L33946Ophthalmology

High

The introduction of coverage for YAG laser capsulotomy following cataract surgery may significantly improve patient outcomes by allowing for timely management of post-operative complications. This cha

LCD L33944: Blepharoplasty — CGS

Policy LCD-L33944Ophthalmology

High

The new LCD for blepharoplasty could significantly impact billing practices for ophthalmology services. Providers must ensure they are in compliance with the updated guidelines to avoid claim denials

LCD L34528: Blepharoplasty, Blepharoptosis and Brow Lift — WPS

Policy LCD-L34528Ophthalmology

High

The upcoming LCD for Blepharoplasty, Blepharoptosis, and Brow Lift from WPS may result in significant changes to billing practices and reimbursement rates starting in 2026. Providers should prepare fo

LCD L34008: Computerized Corneal Topography — CGS

Policy LCD-L34008Ophthalmology

High

The introduction of the LCD for Computerized Corneal Topography by CGS could impact billing processes for ophthalmology practices, ensuring that necessary services are covered and appropriately billed

LCD L33999: Corneal Pachymetry — CGS

Policy LCD-L33999Ophthalmology

High

The introduction of LCD for Corneal Pachymetry may impact billing procedures by establishing clear guidelines for reimbursement, effective from January 22, 2026. Providers will need to familiarize the

LCD L37578: Micro-Invasive Glaucoma Surgery (MIGS) — CGS

Policy LCD-L37578Ophthalmology

High

The introduction of the new Local Coverage Determination (LCD) for Micro-Invasive Glaucoma Surgery (MIGS) is set to impact glaucoma-related billing practices starting April 2026. This may lead to an i

LCD L34064: Panretinal (Scatter) Laser Photocoagulation — CGS

Policy LCD-L34064Ophthalmology

High

The introduction of the LCD for Panretinal Laser Photocoagulation may affect billing practices for ophthalmology services, particularly regarding documentation and coding compliance. It is essential t

Proposed LCD DL40359: Anterior Segment Intraocular Nonbiodegradable Drug-eluting System — Noridian

Policy LCD-DL40359Ophthalmology

Routine

The proposed LCD for Anterior Segment Intraocular Nonbiodegradable Drug-eluting System is under review, with a comment period ending on July 4, 2026. Providers should examine the document thoroughly t

Proposed LCD DL40363: Anterior segment intraocular nonbiodegradable drug-eluting system — NGS

Policy LCD-DL40363Ophthalmology

Routine

This proposed LCD from NGS addresses coverage of anterior segment intraocular nonbiodegradable drug-eluting systems, which are implantable ocular devices typically used for chronic conditions like gla

Proposed LCD DL40367: Anterior segment intraocular nonbiodegradable drug-eluting system — Palmetto GBA

Policy LCD-DL40367Ophthalmology

Routine

The proposed LCD DL40367 introduces coverage for the anterior segment intraocular nonbiodegradable drug-eluting system. Stakeholders are encouraged to review the details and submit their comments by t

Proposed LCD DL40356: Anterior segment intraocular nonbiodegradable drug-eluting system — CGS

Policy LCD-DL40356Ophthalmology

Routine

The proposed LCD DL40356 pertains to the anterior segment intraocular nonbiodegradable drug-eluting system. It is crucial for stakeholders to review this draft before the comment deadline of July 4, 2

Proposed LCD DL40385: Anterior segment intraocular nonbiodegradable drug-eluting system — WPS

Policy LCD-DL40385Ophthalmology

Routine

The proposed LCD DL40385 outlines coverage for anterior segment intraocular nonbiodegradable drug-eluting systems. Stakeholders should review the draft and submit comments by July 4, 2026, to ensure t

LCD L38211: Corneal Hysteresis — WPS

Policy LCD-L38211Ophthalmology

High

This LCD covers Corneal Hysteresis services, which are used to assess the mechanical properties of the cornea. It affects billing procedures for specific eye care assessments related to corneal struct

LCD L34175: Ophthalmic Angiography (Fluorescein and Indocyanine Green) — CGS Administrators

Policy LCD-L34175Ophthalmology

High

The LCD L34175 covers Ophthalmic Angiography procedures, specifically Fluorescein and Indocyanine Green angiography. This affects providers billing for these services under Part A and Part B, as they

LCD L34171: Nasal Punctum-Nasolacrimal Duct Dilation and Probing with or without Irrigation — CGS Administrators

Policy LCD-L34171Ophthalmology

High

This LCD covers the procedures related to nasal punctum-nasolacrimal duct dilation and probing, which may also include irrigation. It affects providers billing for these specific services, mandating a

LCD L34399: Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography) — CGS Administrators

Policy LCD-L34399Ophthalmology

High

This LCD covers services related to posterior segment imaging in ophthalmology, specifically extended ophthalmoscopy and fundus photography. Billing implications indicate that these imaging services a

LCD L34181: Ophthalmic Biometry for Intraocular Lens Power Calculation — CGS Administrators

Policy LCD-L34181Ophthalmology

High

This LCD covers ophthalmic biometry services used for intraocular lens power calculation, which are essential for patients undergoing cataract surgery. Affected services primarily include various biom