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ACG
​
h.o.l.M.E.S.

Automated Clinical Guidelines

Eye movement Desensitization & Reprocessing (EMDR)

Ophthalmology

Allergy Ophthalmics- 
(Alocril, Alomide, Bepotastine, Bepreve, Elestat, Emadine, Lastacaft, Patanol, Pataday, & Zerviate)
Allergy Testing 
Eye
Amniotic Membrane & Limbal Stem Cell Transplantation for the Treatment of Ocular Conditions
Amniotic Membrane-derived Grafts or Wound Coverings
Anesthesia for Cataract Surgery

Indicates Non-covered Service

FloridaBlue
Anterior Segment Aqueous Drainage Device
Special Anterior Segment Photography
Medicare
Aqueous Shunts & Stents for Glaucoma
Artificial Retina
FloridaBlue
Blepharoplasty, Eyelid Surgery, & Brow Lift
Canaloplasty
Canaloplasty
Cataract Removal Surgery
Computerized Corneal Topography
Corneal Collagen Cross-Linking
Corneal Pachymetry
Canthoplasty/
canthopexy (CPT) & Repair of Floppy Eyelid Syndrome (FES)
FloridaBlue
FloridaBlue
Dark Adaptation Examination
Dexamethasone Intracanalicular Ophthalmic Insert
Diagnostic Evaluation & Medical Management of Moderate-severe Dry Eye Disease (DED)
Electroretinography
Endothelial Cell Photography
Extended Ophthalmoscopy
External Ocular Photography
Endothelial Keratoplasty and Corneal Collagen Cross-Linking
FloridaBlue
Endothelial Keratoplasty
Medicare
Fludarabine (Fludara)
Fluorescein Angiography
Fundus Photography
Micro-Invasive Glaucoma Surgery (MIGS)
Graves' Ophthalmopathy Treatments
Medicare
Aetna
Implantable Miniature Telescope (IMT)
Implanted Port Delivery Systems to Treat Ocular Disease
Indocyanine-Green Angiography
Intraocular Lens (IOL) Implants
Implantation of Intrastromal Corneal Ring Segments
Iridotomy by Laser Surgery
Implanted Artificial Iris Devices
Anthem
Humana
FloridaBlue
Keratoprosthesis
Humana
Implantable Miniature Telescope (IMT)
Laser Trabeculoplasty & Peripheral Iridotomy
Laser Vitreolysis
Laser Trabeculoplasty
Macular Degeneration Treatment Procedures
Nasal Punctum-Nasolacrimal Duct Dilation & Probing with or without Irrigation
Medicare
Ocular Photodynamic Therapy (OPT) with Verteporfin
Ophthalmoscopy
Optical Coherence Biometry
Posterior Segment Optical Coherence Tomography
Oxervate (cenegermin) Ophthalmic Solution
Ophthalmic Biometry for Intraocular Lens Power Calculation
Anthem
Panretinal (Scatter) Laser Photocoagulation
 Presbyopia & Astigmatism-Correcting Intraocular Lenses
Prosthetic Eyes & Lens Implants

Photo-

coagulation Macular Drusen

Anthem
FloridaBlue
Anthem
FloridaBlue
Refractive Surgery

Retisert (Fluocinolone Acetonide Implant)

 Anterior Segment Scanning Computerized OphthalmicDiagnostic Imaging (SCODI)
Scanning Computerized Ophthalmic Diagnostic Imaging
Strabismus Correction Surgery
FloridaBlue
Posterior Segment Scanning Computerized OphthalmicDiagnostic Imaging (SCODI)
Visual Fields Testing
Vitrectomy
Visual Information Processinging Evaluation & Orthoptic & Vision Therapy
YAG Laser Capsulotomy
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