Currentpriority healthPolicy N/A

Micro-Invasive Glaucoma Surgery (MIGS)

Defines Priority Health's billing, coding, documentation, and reimbursement guidance for microinvasive glaucoma surgery (MIGS) for applicable commercial, Medicare, and Medicaid members.

Policy Summary

Payerpriority health

PolicyMicro-Invasive Glaucoma Surgery (MIGS)

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionObtain a Pre-Service Organization Determination (PSOD) for Medicare indications that do not meet NCD/LCD or specific medical policy.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

1 unitOnly 1 unit per eye per date of service for CPT 66991 and 66989

013x, 083x, 085xAccepted bill type codes

036X, 045X, 049X, 076XReferenced revenue codes

Follows CMS/MDHHSMedicare/Medicaid guidance

Coverage Criteria and Billing Rules

Coverage criteria and billing rules

Policy Summary

Payerpriority health

PolicyMicro-Invasive Glaucoma Surgery (MIGS)

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionObtain a Pre-Service Organization Determination (PSOD) for Medicare indications that do not meet NCD/LCD or specific medical policy.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

ALL of the following

ALL of the following
- Diagnosis must be coded to the highest level of specificity and include laterality.
- Only 1 unit per eye per date of service may be billed for CPT 66991 and 66989; multiple devices inserted into the same eye on the same day do not permit additional units.
- Medically Unlikely Edits (MUE) may apply; review units allowed by MUE for billed codes prior to claim submission.
- Injecting an antibiotic, steroid, or NSAID during cataract extraction or other eye procedure cannot be billed separately.
ALL of the following
- Complete and thorough documentation must be maintained in the patient’s medical record and must support the medical necessity of the services and the selected ICD-10-CM code(s).
- Documentation must include previous treatments and the patient’s response to those treatments.
- Every page must be legible and include appropriate patient identification information and dates of service; records must include the legible signature of the responsible clinician.
- The submitted CPT/HCPCS code must accurately describe the service performed.
ALL of the following
- Modifiers should be applied when applicable following CMS NCCI guidance and only when supported by documentation.
- Common modifiers (examples)
  - Bilateral Procedure (except when done in ASC).
  - Surgical Care Only.
  - Postoperative Management Only.
  - Waiver of liability statement issued as required by payer policy, individual case.
  - Item or service statutorily excluded, does not meet the definition of any Medicare benefit or, for non‑Medicare insurers, is not a contract benefit.
ALL of the following
- Coverage is considered for services furnished in the setting appropriate to the patient’s medical needs and condition.
- ANY of the following
  - Authorization may be required depending on setting and medical need; consult the Provider Manual.
  - For indications that do not meet an NCD, local LCD, or specific medical policy, a Pre‑Service Organization Determination (PSOD) is required for Medicare.
- Authorization is not a guarantee of payment; medical necessity and documentation requirements still apply and must be supported by the medical record.
ALL of the following
- Reimbursement is determined per Priority Health fee schedules and applicable contract; consult fee schedules for code‑specific rates.
- Accepted bill type codes include 013x, 083x, 085x; referenced revenue codes include 036X, 045X, 049X, 076X.
Failure to follow coding, billing, documentation, modifier, authorization, or contract requirements may lead to claim denial, recoupment, or recovery.

ref

title

ref_x

title_x

Coding, Units, and MUEs

Covered CPT CodesCPTCovered

66991	Micro-invasive glaucoma surgery (example CPT cited)
66989	Micro-invasive glaucoma surgery (example CPT cited)

Units per eye per date of serviceOnly 1 unit should be billed for CPT 66991 and 66989 per eye per date of service, regardless of number of devices inserted.

MUE applicabilityMedically Unlikely Edits (MUE) may apply to billed codes; review units allowed by MUE prior to claim submission.

Source for detailsGet more information on MUE from CMS as referenced in the policy.

Claim preparationVerify allowed units by MUE during claim preparation to avoid denials or reprocessing.

Authorization and Provider Requirements

Prior Authorization

PSOD required for Medicare indications outside NCD/LCD/policy

For Medicare indications that do not meet an NCD, local LCD, or other specific medical policy, complete a Pre-Service Organization Determination (PSOD) before providing the service. Check the Provider Manual for PSOD instructions and obtain authorization when required by setting or medical need.

Initiate PSOD for Medicare cases that fall outside NCD/LCD or specific policy criteria.
Confirm whether authorization is required for the place of service per Provider Manual guidance.

Denial Risk

Authorization is not a guarantee of payment

An authorization or PSOD does not guarantee payment — medical necessity, correct coding, and complete documentation are still required to support reimbursement. Failure to follow billing, coding, documentation, or contractual requirements may result in claim denial, rejection, or recovery.

Maintain complete medical record documentation that supports the CPT/HCPCS and ICD-10 codes billed.
Follow billing and submission guidelines and industry-standard codes; an authorization does not supersede coding or reimbursement rules.

Definitions — MIGS

DefinitionMicroinvasive glaucoma surgery (MIGS) is a minimally invasive surgery that employs microscopic implantable instruments and small incision surgery to reduce intraocular pressure.

Safety noteMIGS is described as a safer option to reduce intraocular pressure than standardized surgery.

Surgical approachUses microscopic implantable instruments and small incisions.

Improving natural drainageProcedures that improve the eye's natural drainage system (trabecular meshwork).

Redirecting or eliminating fluidProcedures that redirect or eliminate excess ocular fluid from the eye.

Reducing fluid productionProcedures that reduce production of ocular fluid inside the eye.