Viscocanalostomy and Canaloplasty — CPB 0435 | AETNA Coverage Update

TL;DR: Aetna, a CVS Health company, modified CPB 0435 covering canaloplasty and viscocanalostomy, effective February 14, 2026. Here's what changes for billing teams.

CPB 0435 in the Aetna system draws a hard line: canaloplasty (CPT 66174 and 66175) is medically necessary for primary open-angle glaucoma (POAG) and pseudo-exfoliation glaucoma — and not much else. The updated Aetna canaloplasty coverage policy adds specificity to the experimental list, naming systems like OMNI, STREAMLINE, and Trab360 explicitly. If your ophthalmology practice bills these procedures under Aetna, this update changes your exposure.

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Quick-Reference Table

Field	Detail Copy
Payer	Aetna, a CVS Health company
Policy	Viscocanalostomy and Canaloplasty
Policy Code	CPB 0435
Change Type	Modified
Effective Date	February 14, 2026
Impact Level	High
Specialties Affected	Ophthalmology, Glaucoma Surgery, Ophthalmic ASC Billing
Key Action	Audit claims for CPT 66174 and 66175 — confirm diagnosis codes map to POAG or pseudo-exfoliation glaucoma before submitting

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Aetna Canaloplasty Coverage Criteria and Medical Necessity Requirements 2026

The Aetna canaloplasty coverage policy is narrow by design. Aetna considers canaloplasty medically necessary for two indications only:

#	Covered Indication Copy
1	Primary open-angle glaucoma (POAG) — including normal-tension glaucoma
2	Pseudo-exfoliation glaucoma

That's the entire covered universe for CPT 66174 (transluminal dilation of aqueous outflow canal, without retention of device or stent) and CPT 66175 (with retention of device or stent). Everything else — corticosteroid-induced glaucoma, uveitic glaucoma, pigmentary glaucoma, glaucoma gene therapy — falls outside coverage under this policy.

The ICD-10-CM codes that support medical necessity here run deep. The POAG codes (H40.1110 through H40.1159 and beyond) cover every laterality and stage combination. For pseudo-exfoliation glaucoma, do not rely on an assumed code range. Pull the full 295-code ICD-10 list from CPB 0435 and match against your clinical and operative documentation to identify the correct diagnosis code. Your billing team should confirm the exact ICD-10 code from the operative and clinical documentation before submitting — Aetna will not pay for 66174 or 66175 against an unsupported diagnosis.

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Aetna Canaloplasty and Viscocanalostomy Exclusions and Non-Covered Indications

This is where CPB 0435 gets detailed — and where your denial risk lives.

Aetna explicitly classifies seven procedure combinations as experimental, investigational, or unproven. These are not soft exclusions. They are flat denials under this coverage policy.

1. Canaloplasty combined with trabeculotomy/goniotomy (e.g., Trab360)
The Trab360 system pairs canaloplasty with trabeculotomy. Aetna does not cover this combination.

2. OMNI and STREAMLINE surgical systems
These systems combine canaloplasty with viscodilation of Schlemm's canal and trabeculotomy/goniotomy. Both are named explicitly as non-covered. If your surgeons use OMNI or STREAMLINE, understand that CPT 66174 or 66175 billed in that context will not pass under this policy.

3. Canaloplasty + trabeculotomy/goniotomy ± viscodilation + cataract surgery
Adding phacoemulsification to the mix doesn't change the calculus. Aetna still considers this combination experimental for POAG treatment.

4. Ab-interno canaloplasty (ABiC) for pigmentary glaucoma
ABiC alone or combined with cataract surgery is non-covered for pigmentary glaucoma. This is an important distinction — canaloplasty for POAG is covered; canaloplasty for pigmentary glaucoma is not.

5. Canaloplasty for all other indications
The policy calls this out directly. Corticosteroid-induced glaucoma, glaucoma gene therapy, and uveitic glaucoma are all non-covered indications.

6. GATT combined with ABiC + phacoemulsification for POAG
Combined gonioscopy-assisted transluminal trabeculotomy (GATT) with ab interno canaloplasty in conjunction with phacoemulsification is experimental, even for POAG.

7. Combined phacoemulsification and viscocanalostomy with Ologen implant
This combination — targeting co-existing cataract and POAG — is explicitly non-covered.

The pattern here is clear. Aetna accepts standalone canaloplasty for POAG. The moment you add a second procedure, a second system, or a different glaucoma subtype, coverage evaporates. If your surgical mix includes any of these combinations, expect claim denial without appeal support built into your documentation.

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Coverage Indications at a Glance

CPT code assignments for experimental and non-covered combinations are not explicitly mapped in CPB 0435. The table below lists covered CPT codes only where the source policy directly supports them. For experimental rows, the procedure description is drawn from the policy — but do not use this table as a CPT code billing guide for those combinations.

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Aetna Canaloplasty Billing Guidelines and Action Items 2026

The effective date of February 14, 2026 is already in the rearview mirror. If your team hasn't audited pending claims, do it now.

Copy Action Items

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CPT, HCPCS, and ICD-10 Codes for Canaloplasty and Viscocanalostomy Under CPB 0435

Covered CPT Codes (When Selection Criteria Are Met)

Code	Type	Description Copy
66174	CPT	Transluminal dilation of aqueous outflow canal; without retention of device or stent [not covered with glaucoma gene therapy]
66175	CPT	Transluminal dilation of aqueous outflow canal; with retention of device or stent [not covered with glaucoma gene therapy]

Not Covered CPT Codes for Indications Listed in CPB 0435

Code	Type	Description Copy
66170	CPT	Fistulization of sclera for glaucoma; trabeculectomy ab externo in absence of previous surgery [not covered per indications listed in CPB]

Other CPT Codes Related to CPB 0435

These codes appear in the policy as related procedures. They are not independently covered under CPB 0435 — their coverage depends on the specific combination billed and the supporting diagnosis.

Key ICD-10-CM Diagnosis Codes

The policy lists 295 ICD-10-CM codes. The core groups billing teams should map to are below.

Primary Open-Angle Glaucoma (Covered Indication)

Glaucoma — Related (Watch for Non-Covered Indications)

Code	Description Copy
H40.1110–H40.1159	Primary open-angle glaucoma — covered under CPB 0435

Cataract Codes (Present Due to Combination Procedure Exclusions)

The cataract ICD-10 codes appear in this policy because several excluded procedure combinations pair canaloplasty with cataract surgery. Their presence here signals what Aetna is watching for — not what it covers under CPB 0435.

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