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LCD L37644: YAG Capsulotomy

LCD L37644, YAG Capsulotomy, is the Local Coverage Determination that Palmetto GBA applies to claims from 7 states (AL, GA, NC, SC, TN, VA, WV), effective 2022-03-10 and first in force 2018-01-29. The policy text runs 193 words, and its billing and coding article A56792 lists 5 ICD-10-CM codes that support medical necessity for 1 procedure codes. No other contractor publishes a policy with this title.

QuickIntell editorial content · Legacy registry date · Review not verified

Data effective
Data currency: Medicare Coverage Database LCD export release of September 24, 2026 (effective September 20, 2026). Next CMS release: weekly (Thursdays) for the MCD.
Contractor
Palmetto GBA
States and territories
7
AL GA NC SC TN VA WV
Revision effective
2022-03-10
Original effective
2018-01-29
Policy text
193 words
Covered ICD-10 codes (articles)
5

Where this LCD applies

Each contract number is a jurisdiction on the remittance; the policy binds claims processed under these contracts and no others.

Contracts that apply LCD L37644
ContractContractorTypeStates
11201Palmetto GBAA and B and HHH MACSC
11301Palmetto GBAA and B and HHH MACVA
11401Palmetto GBAA and B and HHH MACWV
11501Palmetto GBAA and B and HHH MACNC
11202Palmetto GBAA and B and HHH MACSC
11302Palmetto GBAA and B and HHH MACVA
11402Palmetto GBAA and B and HHH MACWV
11502Palmetto GBAA and B and HHH MACNC
10111Palmetto GBAA and B MACAL
10211Palmetto GBAA and B MACGA
10311Palmetto GBAA and B MACTN
10112Palmetto GBAA and B MACAL
10212Palmetto GBAA and B MACGA
10312Palmetto GBAA and B MACTN

Billing and coding: diagnoses and procedure codes

Since 2019 the codes live in the companion article rather than the LCD. Billing and Coding A56792 (Billing and Coding: YAG Capsulotomy) carries the diagnosis and procedure lists the contractor loads as the claims edit. CPT codes are shown as bare numbers because the descriptors are licensed by the AMA; HCPCS Level II descriptors are public and shown.

A56792: Billing and Coding: YAG Capsulotomy (Billing and Coding, effective 2023-08-17)

Covered ICD-10-CM codes
5
1 group
Non-covered ICD-10-CM codes
0
Procedure codes listed
1
Full article
cms.gov record
First 5 covered ICD-10-CM codes in A56792
ICD-10-CMDescription (FY2027)
H26.491—
H26.492—
H26.493—
T85.21XA—
T85.29XA—

Procedure codes: 66821.

Coverage indications, limitations and medical necessity

Neodymium-doped Yttrium Aluminum Garnet (YAG) laser capsulotomies are performed in cases of opacification of the posterior capsule, generally no less than 90 days following cataract extraction. YAG performed less than 90 days following cataract extraction should meet both the indications and limitations of this Local Coverage Determination (LCD). The percentage of patients having this procedure varies greatly among ophthalmologists. Diagnosis of functional visual impairment due to capsular opacification is based on clinical judgment regarding 1 or more of the following:

• Visual loss and/or symptom of glare (visual acuity 20/30 or worse under Snellen conditions, using contrast sensitivity, or simulated glare testing);

• Symptoms of decreased contrast;

• Amount of posterior capsular opacification or;

• Other possible causes of decreased vision following cataract surgery.

Limitations

This procedure will not be covered within 3 months post cataract surgery unless justified by 1 of the following indications:

• Posterior capsular plaque/opacity which cannot be safely removed during primary phacoemulsification cataract procedure

• Capsular block during which cataract remnants and fluid become trapped within the lens capsule and addressed with YAG laser posterior capsulotomy

• Contraction of the posterior capsule with displacement of the intraocular lens.

Summary of evidence (opening)

N/A

the full summary and analysis of evidence are in the CMS record.

Dates, lineage and related policies

Original determination effective
2018-01-29
Current revision effective
2022-03-10
Last reviewed by the contractor
2022-02-01
MCD version
22
Derived from
L30068

Using this policy on a claim

Match the documented indication to the covered indications above before the service is scheduled, carry a diagnosis from the article's covered list on the claim line, and keep the elements the documentation section asks for in the record, because the contractor can request it later through medical review. A denial under this policy arrives as CARC 50 with remark N115; the LCD lookup guide walks through the appeal path and the Advance Beneficiary Notice rules, and the Palmetto GBA hub lists every other active policy from the same contractor.

Frequently asked questions

What does LCD L37644 cover?

Neodymium-doped Yttrium Aluminum Garnet (YAG) laser capsulotomies are performed in cases of opacification of the posterior capsule, generally no less than 90 days following cataract extraction. YAG performed less than 90 days following cataract extraction should meet both the indications and limitations of this Local Coverage Determination (LCD). The percentage of patients having this procedure varies greatly among… The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database export of September 24, 2026.

Which states does LCD L37644 apply to?

Palmetto GBA applies it to Medicare claims in AL, GA, NC, SC, TN, VA, WV. A Local Coverage Determination binds only the contractor that wrote it; the same service in another jurisdiction is judged under that contractor's own policy or, where none exists, claim by claim.

Which diagnosis codes support medical necessity under LCD L37644?

The companion billing and coding article A56792 lists 5 ICD-10-CM codes in 1 group that support medical necessity; the first 5 appear on this page and the complete list is in the article on cms.gov.

How do I appeal a denial under LCD L37644?

The remittance carries claim adjustment reason code 50 with remark code N115, naming the LCD. Compare the documented indication with the policy's covered indications and the article's diagnosis list, then file a redetermination within 120 days with the record attached; if the service genuinely falls outside the policy, the patient can be billed only when a valid Advance Beneficiary Notice was obtained before the service.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-02. Verify against the primary file before billing or contracting decisions.

Disclaimer

The policy text and code lists are reproduced from the CMS Medicare Coverage Database export as an operational reference. Verify against the current LCD and article on cms.gov before billing; coverage depends on the full record and the contractor. Not legal, clinical or billing advice.