|
Diagnostic
and Therapeutic Procedures: Ophthalmology
Effective
June 15, 2002, ocular photodynamic therapy (PDT) with verteporfin
will be an insured service when rendered under specific clinical
conditions by an ophthalmologist for treatment of age-related
macular degeneration or pathologic myopia.
The
following text will be inserted on page J42 (April 2002 edition)
of the Ophthalmology subsection of the Diagnostic and Therapeutic
Procedures section of the Schedule of Benefits on June 15, 2002
directly as follows:
Ocular
photodynamic therapy (PDT) - is, subject to the limitations set
out below, an insured service when rendered by an ophthalmologist.
PDT must include completion and submission of patient
registration and drug requisition forms, establishment of
intravenous access, supervision of drug infusion and personal
application of non-thermal diode laser for activation of
verteporfin.
PDT
is insured only if the patient's clinical condition meets all of
the following:
i.
the patient has predominantly classic subfoveal choroidal
neovascularization (CNV) secondary to either age-related macular
degeneration (AMD) or pathologic myopia. 'Predominantly' means
that the area of classic subfoveal CNV is equal to or greater than
50% of the total CNV lesion, as determined by fluorescein
angiography and documented by retinal photographs retained on the
patient's permanent medical record; and
ii.
treatment is commenced within 30 months after initial
diagnosis of predominantly classic subfoveal CNV secondary to
either AMD or pathologic myopia; and
iii.
the
patient's visual acuity is equal to or worse than 20/40; and
|
