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CMS expands treatment coverage for macular degeneration

The Centers for Medicare & Medicaid Services (CMS) will expand coverage of ocular photodynamic therapy (OPT) with verteporfin for treatment of“wet” age-related macular edema (AMD), the leading cause of vision loss in Americans aged 60 and older.

CMS will permit either optical coherence tomography or fluorescein angiogram to assess treatment response. All other coverage criteria would continue to apply. According to CMS, the coverage expansion recognizes the newer therapies largely supplanted OPT as initial treatment of AMD. OPT remains an option for patients in whom the newer therapies have failed.

Effective for claims with dates of service on or after April 3, 2013, Medicare shall accept, process, and pay for subsequent follow-up visits with either an FA (procedure code 92235) or OCT (procedure codes 92133 or 92134), prior to treatment.

For more information: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM8292.pdf

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