Reimbursement changes far reaching in 2018
WAILEA, Hawaii — Changes in CMS reimbursement are affecting many of the ophthalmic subspecialties this year.
Important for cataract surgery is the expiration of the pass-through status for Omidria (phenylephrine 1% and ketorolac 0.3% intraocular solution, Omeros).
Omidria, which has been used for the past 3 years with pass through status for Medicare payment, can no longer be billed in any fashion as of January 1, when the pass-through expired, Kevin J. Corcoran, COE, CPC, CPMA, FNAO, said at Hawaiian Eye 2018, where he gave on update on coding and reimbursements for the new year.
“That is a normal process, not unique to this particular product,” he said. “As we sit here today, there is no reimbursement, separate or otherwise, for Omidria. And at the same time, you may not charge the patient.”
In glaucoma, minimally invasive glaucoma surgery (MIGS) techniques are “growing dramatically,” he said. One of these devices is Alcon’s Cypass device, which was assigned a CPT Category III code 0474T effective July 1, 2017, for insertion of anterior segment aqueous drainage device in the supraciliary space.
“This code enjoys some reimbursement; they are working out the kinks,” he said, adding that the code is new and not homogeneous for reimbursement across the MIGS space.
Retina experts can look forward to a new anti-VEGF coming on the scene, brolucizumab (Novartis), which is in phase 3 trials for treatment of neovascular age-related macular degeneration.
“Likely as not, you’ll see this in the middle of this year,” Corcoran said, although there is no HCPCS code yet. The new drug may allow every 12-week dosing. Another likely anti-VEGF candidate is abicipar pegol 2 mg, which is also in phase 3 trials, he said.
“You’re going to see more of these over the next few years, but those two ... likely you’ll see in 2018,” Corcoran said.
New for oculoplastic surgeons is the decision to allow patients to pay for cosmetic blepharoplasty when undergoing medical treatment for ptosis.
“The gist of it is that patients can have cosmetic bleph — and pay for it — at the same time as the ptosis procedure,” Corcoran said. “This is new. And I think the oculoplastics community is very pleased with this outcome.”– by Patricia Nale, ELS
Source: Corcoran KJ. What’s new for 2018? Presented at: Hawaiian Eye 2018; Jan. 13-19, 2018; Wailea, Hawaii.
Disclosure: Corcoran reports he is a consultant for Corcoran Consulting Group.