Medicare Coverage Expansion Sets New Milestone for SGHT: 10.4 Million Lives Now Eligible for TearCare Treatment
Regulatory Milestone: TearCare Secures Medicare Fee Schedule for 10.4 Million Beneficiaries
Investors and providers in the eyecare sector just got a reason to take a closer look at Sight Sciences (NASDAQ: SGHT). The company announced that its TearCare System, designed for interventional dry eye treatment, is now recognized with a jurisdiction-wide fee schedule by two major Medicare Administrative Contractors (MACs): Novitas Solutions and First Coast Service Options. This change goes into effect January 1, 2025, unlocking access to TearCare for an estimated 10.4 million Medicare fee-for-service covered lives across a range of key states and regions.
These two MACs collectively represent about 30% of all Medicare fee-for-service lives, marking a significant step forward in reimbursement visibility and potential patient reach. The move comes after rigorous review and paves the way for TearCare claims to be processed—and paid—where medically necessary within these jurisdictions.
| Medicare Contractor | Regions Covered | Estimated Covered Lives (Millions) |
|---|---|---|
| Novitas Solutions, Inc. | AR, CO, DC, DE, LA, MD, MS, NJ, NM, OK, PA, TX | 8.00 |
| First Coast Service Options, Inc. | FL, PR, VI | 2.40 |
| Total | – | 10.40 |
Industry Impact: Improved Visibility and Reimbursement Bolster Growth Outlook
Why does this matter? Reimbursement remains one of the top hurdles for emerging medical technologies, and inclusion on a Medicare fee schedule brings TearCare closer to widespread clinical adoption. Eyecare providers in covered regions can now submit claims for the TearCare procedure, potentially accelerating procedure volumes and, ultimately, revenue for SGHT.
Sight Sciences’ TearCare System targets the underlying cause of evaporative dry eye disease—a major contributor to vision issues in aging populations—through minimally invasive, physician-controlled heat and gland evacuation. This new payment recognition by Medicare further validates the clinical value proposition, enabling providers to address the growing dry eye patient population with greater confidence in reimbursement.
Market Dynamics: Coverage Decision Adds Momentum to SGHT’s Strategic Path
Alongside the regulatory win, SGHT announced that it will update financial guidance—including revenue and adjusted operating expenses—during its upcoming Q3 2025 earnings call. This comes at a time when payer adoption and commercial traction are crucial for SGHT’s long-term market strategy. The recent launch of the Sight Access Portal, providing assistance for providers navigating benefits and reimbursement processes, further supports broad market adoption efforts.
Key Takeaway: Fee Schedule Establishment Unlocks a Larger Addressable Market for TearCare
For investors, the new MAC coverage marks a tangible expansion in addressable market for SGHT and reinforces its commercial and reimbursement execution. While questions remain around uptake speed and regional payer dynamics, this Medicare milestone stands out as a meaningful validation—putting the company on stronger footing for 2025 and beyond. Those interested in healthcare innovation and payer trends will want to watch upcoming guidance for more signals of revenue impact.
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