Coverage Issues Manual
Section 35-100, Photodynamic Therapy, regarding ocular photodynamic therapy (OPT) the policy for the use of OPT for age related macular degeneration (AMD) will remain noncovered for patients with occult and no classic lesions. Effective July 1, 2001, OPT was only covered when used in conjunction with verteporfin (see §45-30 PHOTOSENSITIVE DRUGS). Also effective July 1, 2001, OPT was covered with a diagnosis of neovascular age-related macular degeneration (AMD) with predominately classic subfoveal choroidal neovascular (CNV) lesions (where the area of classic CNV occupies ≥ 50% of the area of the entire lesion) at the initial visit as determined by a fluorescein angiogram.
Section 45-30, Photosensitive Drugs, regarding Verteporfin when used with OPT for the treatment of patients with AMD with occult and no classic lesions will remain noncovered.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: August 20, 2002
DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.