FDA Approval: LUMVOA (VELIGROTUG-VVZE) — Type 1 - New Molecular Entity
Policy FDA-BLA761530 • Ophthalmology
CriticalLUMVOA (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-NDA021980 • Ophthalmology
HighFluorescite (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-BLA761480 • Ophthalmology
RoutineThe 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-L34760 • Ophthalmology
HighThe 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-L38026 • Ophthalmology
HighThe 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-L34061 • Ophthalmology
HighThe 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-L37015 • Ophthalmology
HighThe 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-L34203 • Ophthalmology
HighThe 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-L37027 • Ophthalmology
HighThe 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-L34394 • Ophthalmology
HighThe 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-L34194 • Ophthalmology
HighThe 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-L38299 • Ophthalmology
HighThe 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-L36286 • Ophthalmology
HighThe 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-L38301 • Ophthalmology
HighThe 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-L33946 • Ophthalmology
HighThe 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-L33944 • Ophthalmology
HighThe 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-L34528 • Ophthalmology
HighThe 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-L34008 • Ophthalmology
HighThe 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-L33999 • Ophthalmology
HighThe 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-L37578 • Ophthalmology
HighThe 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-L34064 • Ophthalmology
HighThe 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-DL40359 • Ophthalmology
RoutineThe 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-DL40363 • Ophthalmology
RoutineThis 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-DL40367 • Ophthalmology
RoutineThe 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-DL40356 • Ophthalmology
RoutineThe 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-DL40385 • Ophthalmology
RoutineThe 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-L38211 • Ophthalmology
HighThis 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-L34175 • Ophthalmology
HighThe 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-L34171 • Ophthalmology
HighThis 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-L34399 • Ophthalmology
HighThis 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-L34181 • Ophthalmology
HighThis 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