Reimbursement for glaucoma surgery with an aqueous drainage device often depends on visual field testing.

When considering an aqueous drainage device or shunt for glaucoma, the product directions for use identify eligible patients based on the type of glaucoma, the stage of the disease, and the history of prior treatment. Because payor coverage policies typically mimic these indications, reimbursement depends on a close alignment of the chart documentation with the eligibility criteria. For the Hydrus Microstent (Alcon), the directions for use say it is “indicated for use in conjunction with cataract surgery for the reduction of intraocular pressure (IOP) in adult patients with mild to moderate primary open-angle glaucoma (POAG).” The iStent inject W Trabecular Micro-Bypass System Model G2-W is indicated for use in conjunction with cataract surgery for the reduction of IOP in adult patients with mild to moderate POAG. The Glaukos iStent infinite “is indicated for use in adult patients with primary open-angle glaucoma in whom previous medical and surgical treatment has failed.” Allergan’s Xen gel stent is “intended to reduce intraocular pressure in patients with primary open angle glaucoma where previous medical treatments have failed.” Alcon’s Ex-Press glaucoma filtration device is “intended to reduce intraocular pressure in glaucoma patients where medical and conventional surgical treatments have failed.” The US Food and Drug Administration (FDA) says an aqueous shunt “is intended to reduce intraocular pressure in neovascular glaucoma or glaucoma where medical and conventional surgical treatments have failed.” Significantly, where the stage of glaucoma is mentioned in the directions for use for the aqueous drainage device, it relies on prior visual field (VF) testing for gradation.