CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Intraocular radiation therapies for neovascular (wet) age-related macular degeneration

This policy addresses coverage for intraocular radiation therapies — brachytherapy (epimacular), proton beam therapy, and stereotactic radiotherapy — when used to treat choroidal neovascularization from age-related macular degeneration. It applies to Blue Cross Blue Shield - Rhode Island commercial and Medicare Advantage products as described.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyIntraocular radiation therapies for neovascular (wet) age-related macular degeneration

Policy CodePolicy N/A

Change TypeNo material change

Effective Date

Next Review Date

Key ActionWhen billing for intraocular radiation services or therapies without assigned CPT codes, submit CPT 67299 (unlisted procedure, posterior segment) with appropriate documentation; expect denials for brachytherapy, proton beam, and stereotactic radiotherapy for choroidal neovascularization from AMD as these therapies are not covered or not medically necessary.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

3therapy types reviewed (brachytherapy, proton beam, stereotactic)

1unlisted CPT code recommended

0therapies considered medically necessary

Coverage Determination for Intraocular Radiation Therapies

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Coverage determination

Coverage conclusion for intraocular radiation therapies for choroidal neovascularization associated with age-related macular degeneration:

ALL of the following

Intraocular placement of a radiation source (brachytherapy), proton beam therapy, and stereotactic radiotherapy for treatment of choroidal neovascularization is considered not covered because the evidence is insufficient to determine effects on health outcomes.

Commercial products statement

Commercial product-specific stance:

ALL of the following

Intraocular placement of a radiation source (brachytherapy), proton beam, and stereotactic radiotherapy for choroidal neovascularization is considered not medically necessary due to insufficient evidence.

What Providers Need to Know

Documentation Required

Use of unlisted CPT for billing

When billing for intraocular radiation services or therapies that do not have specifically assigned CPT codes, submit CPT 67299 (Unlisted procedure, posterior segment) with appropriate documentation.

67299

Denial Risk

Services considered not covered / not medically necessary

Providers should expect claims to be denied for brachytherapy (epimacular), proton beam therapy, and stereotactic radiotherapy when used to treat choroidal neovascularization from age-related macular degeneration because these therapies are considered not covered or not medically necessary due to insufficient evidence.

Clinical Context

Age-related macular degeneration (AMD) includes a neovascular (wet/exudative) form that is characterized by development of choroidal neovascularization and associated serous or hemorrhagic detachment of the retinal pigment epithelium, which substantially increases the risk of severe, irreversible vision loss. The standard clinical management for neovascular AMD is repeated intravitreal therapy with agents that target vascular endothelial growth factor (anti‑VEGF), including pegaptanib, ranibizumab, bevacizumab, and aflibercept, and in some cases photodynamic therapy; these intravitreal agents commonly require multiple injections over time.

Various intraocular radiation approaches have been investigated as adjuncts or alternatives to repeated anti‑VEGF injections. These include epimacular brachytherapy (intraocular placement of a beta radiation source such as strontium‑90 via a vitrectomy and handheld cannula delivering a one‑time focal dose of about 24 Gray to the target), external beam proton beam therapy that concentrates dose at depth (Bragg peak), and non‑surgical stereotactic radiotherapy that overlaps external beams at the macula using a robotically controlled device.

Randomized trials and systematic reviews have not shown consistent improvement in visual acuity or net health outcomes with these intraocular radiation therapies. Epimacular brachytherapy trials did not meet noninferiority for visual acuity and were associated with higher rates of adverse events; proton beam trials were halted or failed to show statistically significant stabilization of vision; stereotactic radiotherapy trials reduced the number of anti‑VEGF injections in some studies but did not demonstrate consistent visual acuity benefit. Because available randomized data are inconsistent and raise safety and efficacy concerns, these intraocular radiation approaches are considered investigational and are not covered for treatment of choroidal neovascularization due to AMD.

Key Definitions

Definitions

Brachytherapy (epimacular)Placement of a radiation source (eg, strontium-90) near the macula via vitrectomy and a handheld cannula to deliver a focal beta radiation dose (example: NeoVista Epi-Rad90 delivering ~24 Gy to a target).

Proton beam therapyExternal beam particle therapy using protons (or helium ions) that deposits ionizing energy at a depth (Bragg peak) to concentrate dose in target tissue with less exit dose to surrounding structures.

Stereotactic radiotherapyNon‑surgical, robotically controlled external radiation delivery through the sclera to overlap beams at the macula; performed in an office setting in some systems.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyIntraocular radiation therapies for neovascular (wet) age-related macular degeneration

Policy CodePolicy N/A

Change TypeNo material change

Effective Date

Next Review Date

SourceLink

On This Page

OpenPayer

Intraocular radiation therapies for neovascular (wet) age-related macular degeneration

Coverage Determination for Intraocular Radiation Therapies

Billing and Coding Guidance

What Providers Need to Know

Clinical Context

Key Definitions

Policy Summary Metrics

Intraocular radiation therapies for neovascular (wet) age-related macular degeneration

Coverage Determination for Intraocular Radiation Therapies

Billing and Coding Guidance

What Providers Need to Know

Clinical Context

Key Definitions

Read With / Related Guidance

Policy Summary Metrics