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    v1.0.30
    OpenPayerPolicy UpdatesOphthalmology/OptometryCigna Vizz Presbyopia Coverage Policy | OpenPayer
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    CurrentCignaPolicy IP0763

    Vizz

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    This policy governs coverage determinations for Vizz, a prescription ophthalmic solution indicated for presbyopia in adults, under Cigna-administered health benefit plans. Vizz treatment of presbyopia is considered not medically necessary because presbyopia is a normal age-related condition.

    Policy Summary
    PayerCigna
    PolicyVizz
    Policy CodePolicy IP0763
    Change TypeNo material change
    Effective DateNov 1, 2026
    Last ReviewOct 22, 2026
    Next Review DateN/A
    Key ActionSubmit claims with applicable covered codes and do not bill Vizz treatment for presbyopia, which is subject to denial.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    1.44%Solution concentration
    AdultsFDA-approved population
    1Condition not medically necessary

    Coverage Criteria

    Presbyopia treatment

    Vizz is not medically necessary for the following condition.

    Policy Summary
    PayerCigna
    PolicyVizz
    Policy CodePolicy IP0763
    Change TypeNo material change
    Effective DateNov 1, 2026
    Last ReviewOct 22, 2026
    Next Review DateN/A
    Key ActionSubmit claims with applicable covered codes and do not bill Vizz treatment for presbyopia, which is subject to denial.
    SourceLink
    On This Page
    Coverage CriteriaProvider and Claims GuidanceClinical BackgroundDefinition

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    Not medically necessary

    • Condition: Presbyopia, including any use of Vizz for presbyopia.

      Presbyopia is the irreversible loss of accommodative ability that occurs due to aging and is part of the normal aging process, rather than the result of an illness, injury, disease, or its symptoms.

    Any use of Vizz for presbyopia is not medically necessary, including treatment of presbyopia as a normal age-related decline in the eye’s accommodative ability.

    Vizz for presbyopia is considered not medically necessary because presbyopia is part of the normal aging process and is not the result of an illness, injury, disease, or its symptoms.

    Provider and Claims Guidance

    Billing Rule

    Use applicable covered codes

    Use the most appropriate codes as of the effective date of submission. Claims submitted without applicable covered codes, or billed for conditions or diagnoses not covered under this policy, may be denied as not covered.

    • Reimbursement is not allowed for services billed for conditions or diagnoses that are not covered under the policy.
    • Claims without covered code(s) under the applicable policy will be denied as not covered.
    Denial Risk

    Presbyopia treatment is not medically necessary

    Vizz treatment for presbyopia is considered not medically necessary and is subject to denial. Presbyopia is a natural, age-related loss of accommodative ability rather than an illness, injury, disease, or its symptoms.

    • Any use of Vizz for presbyopia is considered not medically necessary.
    • Vizz is FDA approved for presbyopia in adults, but FDA approval does not establish medical necessity under this policy.

    Clinical Background

    Vizz is a cholinergic muscarinic receptor agonist indicated for the treatment of presbyopia in adults. Presbyopia is the irreversible, age-related loss of the eye’s accommodative ability. Although Vizz is FDA approved for presbyopia in adults, the policy considers this treatment not medically necessary because presbyopia is a normal consequence of aging rather than an illness, injury, disease, or symptom of one.

    Definition

    Definition
    TermPresbyopia
    DefinitionThe irreversible loss of the accommodative ability of the eye that occurs due to aging.