top of page

ACG
​
h.o.l.M.E.S.

Automated Clinical Guidelines

Ophthalmology

Indicates Non-covered Service

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

Retisert (Fluocinolone Acetonide Implant)

Posterior Segment Scanning Computerized OphthalmicDiagnostic Imaging (SCODI)
Visual Information Processinging Evaluation & Orthoptic & Vision Therapy
Scanning Computerized Ophthalmic Diagnostic Imaging
FloridaBlue
Vitrectomy
Strabismus Correction Surgery
Tryptyr02.jpg
Tryptyr (acoltremon ophthalmic solution)  

Indicates Non-covered Service

Implanted Artificial Iris Devices
Implanted Port Delivery Systems to Treat Ocular Disease
Photocoagulation Macular Drusen
 Presbyopia & Astigmatism-Correcting Intraocular Lenses
Anthem
FloridaBlue
Anthem
Anthem
bottom of page