Billing and Coding: Voretigene Neparvovec-rzyl (Luxturna®)

Luxturna® (voretigene neparvovec-rzyl) is covered for patients with vision loss from heritable retinal dystrophies who have confirmed biallelic RPE65 mutations and sufficient viable photoreceptors. Coverage allows a single subretinal administration of 1.5 x 10^11 vector genomes per eye per lifetime, with contralateral eye treatment required between 6 and 18 days after the first eye; claims must include specified HCPCS/NDC codes, surgical CPT codes with site modifiers, and required documentation per LCD L37863.

"Voretigene neparvovec-rzyl (Luxturna®) is covered for treatment of vision loss due to heritable retinal dystrophies in patients with confirmed biallelic RPE65 mutation-associated retinal dystrophy."

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