Ocular Photodynamic Therapy (OPT)

CMS nationally covers ocular photodynamic therapy (OPT) with verteporfin for neovascular AMD when lesions are predominately classic subfoveal CNV (classic area >= 50%), and also for subfoveal occult or minimally classic CNV only if lesions are small (<=4 disk areas) and have documented progression within 3 months prior to initial treatment. Initial lesion classification must be documented by fluorescein angiogram (FA) and follow-up response assessed with OCT or FA; OPT is covered only when used with verteporfin. Juxtafoveal/extrafoveal lesions, inability to obtain an FA, and atrophic ('dry') AMD are nationally non-covered, while other ocular indications are subject to local coverage determinations.

"OPT with verteporfin is covered for neovascular AMD with predominately classic subfoveal CNV when the area of classic CNV >= 50% of the entire lesion at the initial visit as determined by fluoresce..."