WAO Action Alert - Contact NGS Today and Tell them Not to Restrict Access to Sight-Saving Glaucoma Surgeries

Action Requested by August 5

Recently, National Government Services (NGS) published a proposed local coverage determination policy on micro-invasive glaucoma surgery (MIGS) that considers some procedures, including adult goniotomy and canaloplasty, to be “investigational.” Medicare typically does not pay for investigational or experimental treatments.

The Wisconsin Academy of Ophthalmology is concerned that NGS’ proposed policy states that the MIGS procedures below are considered investigational in patients over age 18 for glaucoma management:

• Goniotomy or ab interno trabecular bypass surgery
• Viscocanaloplasty
• Canaloplasty in combination with trabeculotomy ab interno
• Gonioscopy-assisted transluminal trabeculotomy
• Ab Interno Canaloplasty
• Cyclophotocoagulation

WAO is submitting comments to NGS, and also invites members to submit personal comments directly to NGS. Comments should  be sent to NGSDraftLCDComments@anthem.com by August 5, 2023. Be sure to include “Public Comment for Proposed LCD - Micro-Invasive Glaucoma Surgery (MIGS) (DL37244)” in the subject line.  Please note, that due to online security requirements, NGS is unable to accept encrypted emails, compressed attachments, and links. Comment letters are accepted as MS Word and/or Adobe PDF attachments.           

 Key points that you may choose to include are:

• There is extensive published data and clinical experience over more than 10 years using MIGS, including goniotomy and canaloplasty to treat glaucoma.
• Patients with glaucoma, which disproportionately affects Black and Hispanic patients, need access to a range of surgical procedures.
• Trabecular meshwork stents have an important role in treating patients with glaucoma and coverage for standalone trabecular stents under CPT code 0671T is appreciated.
• There are some patients for whom treatment with medications is inadequate and their glaucoma is not at a stage requiring more invasive procedures such as trabeculectomy and tube shunts. For these patients, MIGS help preserve quality of life and reduce total costs to the healthcare system.
• Cyclophotocoagulation can be vision-saving in patients with no other options and decades of literature evidence support its efficacy, thus it should not be considered investigational.
• To ensure that Medicare beneficiaries with glaucoma have meaningful access to these transformative procedures, the draft LCD should be revised to include coverage for:

WAO Letter