Medicare expands OCT coverage

July 24, 2013

The Centers for Medicare & Medicaid Services (CMS) expanded coverage of ocular photodynamic therapy (OPT) (CPT 67221/67225) with verteporfin (HCPCS J3396) for “wet” age-related macular degeneration (AMD).

The CMS revised the requirements for testing to permit either optical coherence tomography (OCT) or fluorescein angiogram (FA) to assess treatment response. All other coverage criteria will continue to apply.

The new coverage policy was actively implemented July 16.

The policy officially took effect April 3, 2013, though Medicare carriers will not retroactively adjust claims unless they are brought to their attention, the CMS noted.

The CMS advised eye care practitioners to make sure their billing staffs are aware of these changes.

For additional information, visit http://tinyurl.com/octcoverage.

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