Ophthalmology reimbursement alerts

This final LCD from CGS (J15) governs coverage criteria for external ocular photography services in Kentucky and Ohio, effective September 3, 2026. It establishes the medically necessary indications,

This final LCD from WPS (J5/J8) establishes coverage criteria for Micro-Invasive Glaucoma Surgery (MIGS) across six Midwestern states, effective August 27, 2026. It will govern which MIGS procedures a

Difluprednate ophthalmic emulsion (Sandoz NDA022212) is administered via the ophthalmic route, which supports a Part D billing pathway as indicated. As an ophthalmic corticosteroid emulsion, it is typ

This active final LCD from Wellpoint Federal establishes coverage criteria for Micro-Invasive Glaucoma Surgery (MIGS) under Medicare Part A and Part B, effective April 1, 2026. It defines the specific

This final LCD from WPS (Jurisdictions 5 and 8) establishes coverage criteria for cataract surgery across six Midwestern states, effective July 30, 2026. It governs both Part A and Part B billing, mea

This active final LCD from Wellpoint Federal governs coverage criteria for cataract extraction procedures under Medicare Part A and Part B, effective April 1, 2026. It establishes the clinical indicat

This active final LCD from Wellpoint Federal governs coverage of corneal pachymetry (L33630), effective April 1, 2026. It establishes the indications, limitations, and documentation requirements under

This final LCD (L38014) from Wellpoint Federal establishes coverage criteria for Corneal Hysteresis testing, effective April 1, 2026. It defines the indications, documentation requirements, and limita

This active final LCD from Wellpoint Federal governs coverage criteria for posterior segment imaging services, including extended ophthalmoscopy and fundus photography, effective April 1, 2026. It est

This active final LCD from Wellpoint Federal governs coverage criteria for ophthalmic biometry used to calculate intraocular lens (IOL) power, effective April 1, 2026. It establishes the documentation

LCD L33628 establishes coverage criteria for Panretinal (Scatter) Laser Photocoagulation under both Part A and Part B, administered by Wellpoint Federal, effective April 1, 2026. As a final, active LC

This active final LCD from Wellpoint Federal governs coverage criteria for Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI), effective April 1, 2026. It establishes the indications, documen

This active final LCD (L33574) from Wellpoint Federal governs coverage criteria for Visual Fields Testing under Medicare Parts A and B, effective April 1, 2026. It establishes the medically necessary

This active final LCD from Wellpoint Federal governs coverage criteria for Visual Electrophysiology Testing, effective April 1, 2026. It establishes Medicare coverage requirements for procedures such

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

This proposed LCD from NGS addresses coverage criteria for anterior segment intraocular nonbiodegradable drug-eluting systems, which are implantable devices used to treat ocular conditions such as chr

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

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

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

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

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

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

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

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