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CMS: Expanded indications for PDT now covered
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WASHINGTON — The Centers for Medicare and Medicaid Services has extended the indications for which it will reimburse photodynamic therapy with verteporfin, the American Academy of Ophthalmology announced.
Effective April 1, Medicare will reimburse for PDT procedures with Visudyne (verteporfin for injection, Novartis) in select patients with subfoveal occult with no classic choroidal neovascularization associated with age-related macular degeneration or with subfoveal minimally classic CNV in AMD (where the area of classic CNV occupies less than 50% of the entire lesion), according to the AAO.
The AAO press release noted that CMS coverage is limited to lesions that are less than or equal to four disc areas and that show evidence of disease progression.
Before April 1, CMS reimbursed for PDT only for predominantly classic CNV in AMD. The agency announced in January that it intended to cover the extended indications after the Medicare Coverage Advisory Committee overwhelmingly voted in September 2003 to support the treatment.
In an unrelated move, the CMS also increased Medicare reimbursement for PDT by $100 beginning April 1.
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