ASCRS Position Statement on Cyclodialysis with Scleral Reinforcement
The surgical management of glaucoma remains a substantial clinical challenge. Despite significant advances in medical therapy and minimally invasive glaucoma surgery (MIGS), glaucoma continues to be a progressive and irreversible cause of vision loss for many patients. Over time, a significant proportion of patients experience waning efficacy of prior medical and surgical interventions and require additional intervention to preserve vision and quality of life.
A recently developed surgical approach utilizing controlled cyclodialysis with scleral reinforcement has emerged as an important option for selected patients with refractory glaucoma, particularly those who have previously undergone canal-based MIGS procedures and/or laser trabeculoplasty but continue to demonstrate inadequate intraocular pressure control. This procedure enhances aqueous outflow through the uveoscleral pathway and addresses an area of unmet need in glaucoma care following the withdrawal from the U.S. market of the only prior implant specifically designed to enhance this pathway.
At present, surgeons performing this procedure have relied upon existing Category I CPT descriptors that most specifically describe the work being performed, including CPT code 66740 (creation of cyclodialysis cleft) and CPT code 67255 (scleral reinforcement with graft). These codes describe established surgical elements that are integral to the procedure. The scleral allograft utilized during surgery serves a structural reinforcing function by supporting and maintaining the surgically created outflow space necessary for controlled cyclodialysis and aqueous egress. Without the scleral reinforcement, the cleft would likely close, often unpredictably, resulting in damaging elevations of intraocular pressure. Accordingly, both elements of the procedure are essential.
ASCRS recognizes that these existing codes were not originally developed specifically for this exact procedural configuration. However, until implementation of the newly established Category III CPT code, effective January 1, 2027, it is the position of ASCRS that physicians should report this procedure using the currently available CPT codes that most accurately and specifically describe the surgical work performed, consistent with longstanding principles of CPT reporting.
Importantly, the alternative use of an unlisted procedure code creates substantial barriers to patient access. Unlisted codes are frequently associated with delayed adjudication, inconsistent reimbursement, administrative burden, and uncertainty for ambulatory surgery centers and physicians. In many settings, reliance on unlisted coding may effectively render otherwise appropriate surgical care inaccessible to patients with progressive glaucoma who have limited remaining therapeutic options.
ASCRS believes that appropriate reimbursement mechanisms should remain available during the transition period preceding implementation of the Category III code. The practice of medicine must remain focused on preserving patient vision and supporting access to medically necessary care. Coding policy should facilitate, rather than impede, appropriate treatment for patients with progressive glaucoma at risk for irreversible vision loss.
Accordingly, ASCRS supports the continued use of the currently available CPT codes that most specifically describe the surgical components of this procedure until the dedicated Category III code becomes effective on January 1, 2027.
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