Photodynamic Therapy

Photodynamic therapy (OPT) is nationally covered only when used with verteporfin for patients with neovascular AMD who have predominantly classic subfoveal CNV lesions (classic component ≥50% of the lesion) as documented by fluorescein angiography at the initial visit. OPT is non-covered for occult-only CNV and for other AMD types such as minimally classic or atrophic (dry) AMD; other ocular indications (e.g., pathologic myopia, presumed ocular histoplasmosis) are not nationally covered but may be considered under local Medicare Administrative Contractor discretion. Follow-up requires OCT or FA to assess response, and there are no specified limits on visual acuity, lesion size, or number of re-treatments.

"Ocular photodynamic therapy (OPT) is covered only when administered in conjunction with the photosensitizing drug verteporfin."

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