Ocular Photodynamic Therapy with Verteporfin for Macular Degeneration

CMS NCA document | source_status=Closed | review_type=2nd Recon | public_comment_open=False | document_id=CAG-00066R2

The Centers for Medicare and Medicaid Services has decided to retain its national noncoverage policy of ocular photodynamic therapy with verteporfin in the treatment of subfoveal occult with no classic choroidal neovascularization associated with age-related macular degeneration. This decision memorandum does not affect our national coverage policy for OPT with verteporfin for predominantly classic subfoveal CNV related to AMD. Other uses of OPT with verteporfin to treat AMD not already addressed by CMS will continue to be non-covered. These include the following AMD indications: Patients with minimally classic CNV lesions (where the area of classic CNV occupies < 50% of the area of the entire lesion); Patients with juxtafoveal or extrafoveal CNV lesions (lesions outside the fovea); Patients who are unable to obtain a fluorescein angiogram; and Patients with atrophic or "dry" AMD. OPT with verteporfin for other ocular indications, such as pathologic myopia or the presumed ocular histoplasmosis syndrome, is not addressed in this decision memorandum nor in our national coverage policy, and continues to be eligible for coverage through individual contractor discretion.