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MP 7.01.33 Posterior Capsulotomy


Medical Policy    
Original Policy Date
Last Review Status/Date
Reviewed by consensus/3:2003
  Return to Medical Policy Index


Our medical policies are designed for informational purposes only and are not an authorization, or an explanation of benefits, or a contract.  Receipt of benefits is subject to satisfaction of all terms and conditions of the coverage.  Medical technology is constantly changing, and we reserve the right to review and update our policies periodically.




Opacification of the posterior capsule is a consequence of cataract surgery. Opacification may increase, and thus a decrease in visual function occurs. The most commonly used technique for treating posterior capsule opacification is by neodymium:Yag capsulotomy.




The use of an Nd:Yag laser is considered medically necessary for performing posterior capsulotomy if there is a decrease in visual acuity following cataract surgery when the ability to carry out needed activities is impaired and when an eye examination confirms the diagnosis of posterior capsular opacification and excludes other ocular causes of functional impairment.



Policy Guidelines

Laser capsulotomy should never be scheduled at the same time cataract surgery is scheduled or performed. Justification for performing laser capsulotomy should be well documented due to increased risk of retinal detachment. Nd:Yag capsulotomy should not be performed prophylactically. For purposes of improving functional impairment, Nd:Yag capsulotomy should seldom be necessary in the first 3 months after surgery and should be infrequently required prior to 6 months.



Benefit Application

No applicable information




A search of the literature was completed through the MEDLINE database for the period of January 1992 through October 1995. The search strategy focused on references containing the following Medical Subject Headings:

– Capsulotomy
– Laser Surgery

Research was limited to English-language journals on humans.

See also:

Technology Evaluation and Coverage 1986: p. 178
AHCPR, management of cataract in adults, publication No. 93-0543.





CPT  66821  Discission of secondary membranous cataract (opacified posterior lens capsule and/or anterior hyaloid); laser surgery (e.g., YAG laser) (one or more stages) 
ICD-9 Procedure  13.64  Discission of secondary membrane [after cataract] 
ICD-9 Diagnosis  366.53  After cataract, obscuring vision 
HCPCS  No code 
Type of Service  Surgery 
Place of Service  Inpatient




Capsulotomy, posterior, laser
Laser Nd:Yag for posterior capsulotomy
Neodymium, (Nd:Yag) laser for posterior capsulotomy



Policy History

Date Action Reason
3/31/96 Add to Surgery section New policy
05/17/02 Replace policy Policy reviewed without literature review; new review date only
10/9/03 Replace policy Policy reviewed by consensus without literature review; no changes in policy; no further review scheduled


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