Noridian Changes to Goniotomy LCD

September 7, 2022

07-09-2022 Sandy Stofa closed

Noridian has made changes to their Goniotomy coverage policy effective October 1^st, 2022.

It states:

“Since there is no specific CPT® code for goniopuncture or so-called microgoniotomy procedures, the unlisted CPT® code 66999 (unlisted procedure, anterior segment of the eye) should be reported in these instances.

Any procedures performed which consists of single or multiple small punctures and/or injections of small amounts of viscoelastic, or other limited interventions should be reported using unlisted CPT® code 66999.

Specifically, goniotomy (CPT® code 65820) should not be coded in addition to other angle surgeries, stent insertions, or Schlemm canal implants or if the incision into the trabecular meshwork is minimal or simply incidental to another procedure.

In order to report a goniotomy, an extensive incision of the trabecular meshwork around the eye, at the least and generally more than 3 clock hours, must have been performed.

Documentation regarding the reasonable and necessary premise for the work must be present. Noridian may request additional documentation on a case-by-case basis.

Documentation Requirements: The patient’s medical record must contain documentation that fully supports the medical necessity for services included in the LCD. (See “Indications and Limitations of Coverage.”) This documentation includes, but is not limited to, relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures. The medical record and/or test results documenting medical necessity should be maintained and made available on request. iStent, iStent inject, and Hydrus must be performed in conjunction with cataract surgery on the same date of service and documented in the medical record.”

This is consistent with instructions from the American Academy of Ophthalmology, and the American Medical Association’s publication, CPT Assistant.

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