What changes has CMS made to the NCD expanding the coverage of OPT with verteporfin?
After a thorough review and reconsideration, CMS has made a determination that the evidence is adequate to conclude that OPT with verteporfin is reasonable and necessary for treating AMD in two additional clinical instances: • Subfoveal occult with no classic choroidal neovascularization (CNV) with AMD, and • Subfoveal minimally classic CNV (where the CNV area occupies <50% of the area of the entire lesion) associated with AMD. The above 2 indications are considered reasonable and necessary only when: • The lesions are small (4 disk areas or less in size) at the time of initial treatment or within the 3 months prior to initial treatment, and, • The lesions have shown evidence of progression within the 3 months prior to initial treatment.
