Medical Policy Updates

Notification of Policy Revisions Effective April 7, 2005 (Posted January 20, 2004)

Medical Policy	Revision
Photodynamic Therapy, Ocular	Specialty Matched Consultant Advisory Panel review-1/5/05. Under "Description" section, added information regarding occult and classic CNV and central serous chorioretinopathy. Added "choroidal neovascularization secondary to central serous chorioretinopathy." as investigational. Under "Billing/Coding" section, deleted code J3395-code was deleted in 2005 HCPCS. Medical term definitions and reference sources added. Notification given 1/20/05. Effective date 4/7/05.
Phototherapeutic Keratectomy	Specialty Matched Consultant Advisory Panel review - 1/5/2005. Notification of new policy titled "Phototherapeutic Keratectomy". PTK may be considered medically necessary when used as an alternative to a lamellar keratoplasty in the treatment of visual impairment or irritative symptoms related to corneal scars, opacities, or dystrophies extending beyond the epithelial layer. PTK is considered not medically necessary when used as an alternative to a superficial mechanical keratectomy in treating patients with superficial corneal dystrophy, epithelial membrane dystrophy, and irregular corneal surfaces due to Salzmann's nodular degeneration or keratoconus nodules. Investigational applications of PTK include treatment of recurrent corneal erosions and infectious keratitis. Notification given 1/20/05. Effective date 4/7/05.

Medical Policy

Revision

Photodynamic Therapy, Ocular

Specialty Matched Consultant Advisory Panel review-1/5/05. Under "Description" section, added information regarding occult and classic CNV and central serous chorioretinopathy. Added "choroidal neovascularization secondary to central serous chorioretinopathy." as investigational. Under "Billing/Coding" section, deleted code J3395-code was deleted in 2005 HCPCS. Medical term definitions and reference sources added. Notification given 1/20/05. Effective date 4/7/05.

Phototherapeutic Keratectomy

Specialty Matched Consultant Advisory Panel review - 1/5/2005. Notification of new policy titled "Phototherapeutic Keratectomy". PTK may be considered medically necessary when used as an alternative to a lamellar keratoplasty in the treatment of visual impairment or irritative symptoms related to corneal scars, opacities, or dystrophies extending beyond the epithelial layer. PTK is considered not medically necessary when used as an alternative to a superficial mechanical keratectomy in treating patients with superficial corneal dystrophy, epithelial membrane dystrophy, and irregular corneal surfaces due to Salzmann's nodular degeneration or keratoconus nodules. Investigational applications of PTK include treatment of recurrent corneal erosions and infectious keratitis. Notification given 1/20/05. Effective date 4/7/05.