Article Date: 10/1/2004

Lasers for AMD
An at-a-glance guide to today's products.

Like all other ophthalmic instruments, lasers continue to evolve. Many of today's models represent improvements in size and portability as well as the capability to "multitask." The accompanying grid lists key parameters of lasers used to treat AMD to assist you in making your next purchase decision.

In addition, some changes in reimbursement policy involving lasers for AMD have recently taken place.

REIMBURSEMENT FOR TTT

The results of the transpupillary thermotherapy (TTT) for wet AMD trial (TTT4CNV) are expected to be released this quarter. In the meantime, while no national coverage policy exists, the number of Medicare carriers that reimburse physicians for performing TTT has increased.

Level III CPT Code 0016T is defined as "destruction of localized lesion of choroid (for example, choroidal neovascularization); transpupillary thermotherapy (one or more sessions)."

Carriers that have issued written statements in their Medicare Part B Bulletins that they will cover TTT for choroidal neovascularization (CNV) are:

Noridian. Covers Alaska, Arizona, Colorado, Hawaii, Iowa, Nevada, North Dakota, Oregon, South Dakota, Washington, and Wyoming. Doctors submit electronically under 0016T with ICD 362.52.

Cigna. Covers Idaho, North Carolina, and Tennessee. Doctors submit electronically under 0016T. TTT is covered for diagnoses described by ICD-9-CM code 362.51 or 362.52.

National Heritage Insurance Company. Covers TTT in California. Single payment for 1 or more of a series of treatment sessions under 0016T with 190.6, 362.16, or 362.52 being acceptable diagnoses.

Carriers with Medicare Part B Local Medical Review Policies stating that they will cover TTT for choroidal neovascularization are:

HGS Administrators. Covers Pennsylvania. Instructs doctors to code under 0016T with ICD-9 codes of 190.5, 190.6, or 362.52.

Cahaba Government Benefit Administrators. Covers Mississippi. Instructs doctors to code under 0016T with ICD-9 codes of 190.5, 190.6, 224.5, 224.6, or 362.52.

REIMBURSEMENT FOR TREATING OCCULT AND MINIMALLY CLASSIC LESIONS

Also in the area of reimbursement for AMD treatment, effective April 1, 2004, ocular photodynamic therapy (OPT) with verteporfin (Visudyne) continues to be approved for a diagnosis of neovascular AMD with predominately classic subfoveal 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.

In addition, after further review of its Aug. 20, 2002, noncoverage policy, the Centers for Medicare and Medicaid Services determined that the evidence is adequate to conclude that OPT with verteporfin is reasonable and necessary for treating:

► subfoveal occult with no classic CNV associated with AMD

► subfoveal minimally classic CNV (where the area of classic CNV occupies <50% of the area of the entire lesion) associated with AMD.

Those 2 indications are considered reasonable and necessary only when the lesions are small (4 disk areas or less) at the time of initial treatment or within the 3 months prior to initial treatment, and when the lesions have shown evidence of progression within the 3 months prior to initial treatment.

Evidence of progression must be documented by deterioration of visual acuity (at least 5 letters on a standard eye examination chart), lesion growth (an increase in at least 1 disk area), or the appearance of blood associated with the lesion.

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Retinal Physician, Issue: October 2004