CurrentCignaPolicy N/A

Ophthalmology - Vizz

Coverage policy document for Vizz (aceclidine 1.44% ophthalmic solution) intended to guide interpretation of Cigna-administered health benefit plans. This part contains only the policy header and general instructions for use; no specific coverage, criteria, codes, or billing rules are included in this part.

Policy Summary

PayerCigna

PolicyOphthalmology - Vizz

Policy CodePolicy N/A

Change TypeNew policy — Vizz excluded for presbyopia

Effective Date

Next Review Date

Key ActionVizz is considered not medically necessary for presbyopia; providers should not expect coverage for any use for presbyopia and should document that treatment is for an age-related refractive change rather than disease.

SourceLink

POLICY UPDATE CHANGES

New Policy indicating Vizz is not medically necessary for presbyopia.

0Covered Indications specified in this part

0Billing codes listed in this part

part 2 of 3Document part status

1Primary Excluded Indication (presbyopia)

IP0763

Coverage Summary

This part of the Cigna Coverage Policy for Vizz (aceclidine 1.44% ophthalmic solution) is informational and serves as the policy header only. It explains how Coverage Policies apply within Cigna-administered health benefit plans and reiterates that medical directors may exercise discretion. The document part does not contain clinical criteria or coverage rules except that Vizz is stated as not medically necessary for presbyopia.

Not Medically Necessary

Vizz for the treatment of presbyopia is considered NOT medically necessary.

ALL of the following

Examples include (not all inclusive):: Presbyopia

Provider Actions

Documentation Required

Do not submit Vizz for medical necessity coverage

Vizz is considered not medically necessary for presbyopia; providers should not expect coverage for any use for presbyopia and should document that treatment is for an age-related refractive change rather than disease.

Applicable Codes

There are no billing, coding, or reimbursement instructions in this document part; the policy's code groups are empty and no codes are listed.

Clinical Evidence

Evidence: FDA prescribing information — Vizz [prescribing information], LENZ Therapeutics, Inc., July 2025. Full clinical criteria are not included in this header part.

Background & Definitions

Background: This is the Cigna Coverage Policy header for Vizz (aceclidine 1.44% ophthalmic solution), and it includes standard 'Instructions for Use' text describing how Coverage Policies should be interpreted relative to member benefit documents and medical director discretion. This part contains no clinical criteria, coding, or billing rules.

Term	Definition
Vizz	Vizz™ (aceclidine 1.44% ophthalmic solution - Lenz Therapeutics)
Presbyopia	The irreversible loss of the accommodative ability of the eye that occurs due to aging; considered a normal aging process.

Revision History

11/01/2025Policy CreatedLatest

Policy created as a new policy (Summary of Changes = New Policy). New Policy indicating Vizz is not medically necessary for presbyopia.