
Final LCDs from MACS Lead To Questions on Coverage for Certain MIGS Procedures for Glaucoma Treatment
11-10-23 (by: Scott Gleason) A series of decisions by Medicare Administrative Contractors (MACs) is causing concern among healthcare providers and patients as they signal significant shifts in the coverage of Micro-Invasive Glaucoma Surgery (MIGS). On November 9, 2023, four prominent MACs—Palmetto GBA, Celerian Group Company, National Government Services, and Noridian Healthcare Solutions—individually released local coverage determinations (LCDs) that are set to take effect on December 24, 2023.
The LCDs have sparked attention for categorizing certain glaucoma management procedures as “investigational.” One procedure impacted by this reclassification is canaloplasty in combination with trabeculotomy which would impact procedures such as the OMNI system from Sight Sciences. The LCDs also added some procedures such as goniotomy but, they come with certain coverage limitations. The MACs who have issued the LCDs comprise about 60% of ophthalmology procedures in the United States.
There has been strong feedback from MIGS companies in relation to these LCDs and most have not yet provided guidance on the impact to revenue in 2024 such as Glaukos on its third quarter earnings call. Company’s are pushing to delay implementation believing the changes are not supported by clinical evidence and have stated intentions to initiate LCD reconsideration processes.