The American Society of Cataract and Refractive Surgery (ASCRS) released a position statement addressing appropriate reimbursement coding for cyclodialysis with scleral reinforcement, a surgical technique increasingly used to treat patients with refractory glaucoma who have exhausted other treatment options. According to the organization, the statement was prompted by insurers' inconsistent coding and reimbursement policies for ab interno cyclodialysis procedures, which have led to confusion and claim denials in some cases.
Despite advances in medical therapy and minimally invasive glaucoma surgery (MIGS), glaucoma remains a leading cause of progressive, irreversible vision loss. For a significant number of patients, the benefits of earlier interventions diminish over time, requiring additional treatment to preserve sight and quality of life. Cyclodialysis with scleral reinforcement has emerged as an important option for these patients, particularly those who have previously undergone canal-based MIGS procedures or laser trabeculoplasty but continue to experience inadequate intraocular pressure control, the ASCRS said.
According to the ASCRS, the procedure addresses an unmet need in glaucoma care following the withdrawal from the US market of the only implant previously designed to enhance outflow through the uveoscleral pathway. Surgeons currently report the procedure using existing Category I CPT codes—66740 (creation of cyclodialysis cleft) and 67255 (scleral reinforcement with graft)—that most specifically describe the surgical work performed. A dedicated Category III CPT code is scheduled to take effect January 1, 2027.
ASCRS's position statement explains that until the new code takes effect, physicians should continue reporting the procedure using the currently available codes that most accurately describe its components, consistent with longstanding CPT reporting principles. The Society cautions that the alternative—use of an unlisted procedure code—creates substantial barriers to patient access, including delayed adjudication, inconsistent reimbursement, and added administrative burden for physicians and ambulatory surgery centers.
“The practice of medicine must remain focused on preserving patients' vision and supporting access to medically necessary care,” ASCRS said in its statement. “Coding policy should facilitate, rather than impede, appropriate treatment for patients with progressive glaucoma who have limited remaining therapeutic options.”
ASCRS said it supports the continued use of existing, accurately descriptive CPT codes for this procedure through the transition period, ensuring that appropriate reimbursement mechanisms remain in place until the Category III code becomes effective on January 1, 2027.
Read the full position statement here.