Micro Invasive Glaucoma Surgery L38301 - R6 - Effective November 17, 2024

Date Posted: September 18, 2025

This Local Coverage Determination (LCD) has been revised under contractor numbers: 02101 (AK), 02201 (ID), 02301 (OR), 02401 (WA), 03101 (AZ), 03201 (MT), 03301 (ND), 03401 (SD), 03501 (UT), and 03601 (WY).

Effective Date: November 17, 2024

Summary of Changes:

Under Coverage Indications, Limitations and/or Medical Necessity, Limitation of Coverage #3 changed i to is.

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