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: 02102 (AK), 02202 (ID), 02302 (OR), 02402 (WA), 03102 (AZ), 03202 (MT), 03302 (ND), 03402 (SD), 03502 (UT), and 03602 (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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Last Updated Sep 18 , 2025