CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Intraocular Radiotherapy for Neovascular (Wet) Age-Related Macular Degeneration — Coverage Criteria

This policy addresses coverage for intraocular radiation therapies — brachytherapy, proton beam therapy, and stereotactic radiotherapy — when used to treat choroidal neovascularization from age-related macular degeneration for BCBSRI members.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyIntraocular Radiotherapy for Neovascular (Wet) Age-Related Macular Degeneration — Coverage Criteria

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionUse unlisted posterior segment procedure code 67299 when billing these services and note that prior authorization is not applicable per policy.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

3therapy types

Not covered / NMNcoverage stance

67299recommended CPT

multiple RCTsevidence

no approvalsregulatory status

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 and Criteria

Coverage determination

Coverage stance differs by product

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

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

For Medicare Advantage members, intraocular placement of a radiation source (brachytherapy), proton beam therapy, and stereotactic radiotherapy to treat choroidal neovascularization from age-related macular degeneration are not covered. This determination reflects the plan’s assessment that available evidence is insufficient to determine the effects of these technologies on health outcomes.

For Commercial products, intraocular placement of a radiation source (brachytherapy), proton beam therapy, and stereotactic radiotherapy for choroidal neovascularization due to age-related macular degeneration are considered not medically necessary. The policy basis is that current evidence is insufficient to establish a net health benefit from these interventions.

This policy addresses intraocular radiation-based therapies — specifically brachytherapy (intraocular placement of a radiation source), proton beam therapy, and stereotactic radiotherapy — when used to treat choroidal neovascularization associated with neovascular (wet) age-related macular degeneration. Coverage stance differs by product: these therapies are not covered for Medicare Advantage and not medically necessary for Commercial products due to insufficient evidence of benefit.

Coding and Billing Guidance

Unlisted CPT codes recommendedCPT

67299

Unlisted procedure, posterior segment

Provider Actions, Billing, and Prior Authorization

Prior Authorization

Prior authorization — Not applicable

Prior authorization is not required or applicable for intraocular brachytherapy, proton beam therapy, or stereotactic radiotherapy under this policy.

Note

Standard clinical management — anti‑VEGF therapies

Manage neovascular (wet) AMD with standard intravitreal anti-VEGF agents (pegaptanib, ranibizumab, bevacizumab, aflibercept); these are the usual alternatives to intraocular radiation and remain standard clinical management.

Anti-VEGF intravitreal agents: pegaptanib, ranibizumab, bevacizumab, aflibercept
Photodynamic therapy is an older approach largely replaced by anti-VEGF therapies

Background and Scope

Age-related macular degeneration (AMD) is a leading cause of severe vision loss in older adults; the neovascular ("wet") form is characterized by choroidal neovascularization and carries a higher risk of irreversible visual impairment. Standard management for neovascular AMD is repeated intravitreal anti-VEGF therapy; intraocular radiation approaches (brachytherapy, proton beam, stereotactic) have been investigated as alternative or adjunctive treatments but, per this policy, evidence is currently insufficient to demonstrate improved health outcomes.

Definitions of Therapies Discussed

Epimacular brachytherapy — key characteristics

Procedure nameEpimacular brachytherapy (NeoVista Epi-Rad90 / Vidion EMBT)

Delivery methodHandheld cannula inserted into vitreous cavity during standard vitrectomy; radioactive source (strontium-90) advanced to cannula tip and held over lesion

Dose and targetSingle one-time peak beta particle dose of approximately 24 Gray to a target area up to 3 mm depth and 5.4 mm diameter

Intended targetSubfoveal choroidal neovascular lesion (choroidal neovascularization)

Radiation exposureDesigned to minimize exposure outside target; dose believed below toxicity threshold for retina and optic nerve

Proton beam therapy — definition and characteristics

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyIntraocular Radiotherapy for Neovascular (Wet) Age-Related Macular Degeneration — Coverage Criteria

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionUse unlisted posterior segment procedure code 67299 when billing these services and note that prior authorization is not applicable per policy.

SourceLink

On This Page

Billing Rule

Billing guidance — use unlisted posterior segment code 67299

When billing for services or therapies addressed in this policy for which no specific CPT code is assigned, report the unlisted posterior segment procedure code 67299.

Use CPT 67299 — Unlisted procedure, posterior segment

Denial Risk

Claims handling and denial risk — expect denial/noncoverage

Claims for intraocular brachytherapy, proton beam therapy, or stereotactic radiotherapy to treat choroidal neovascularization due to AMD are subject to denial or noncoverage depending on product.

Medicare Advantage: these procedures are considered not covered.
Commercial products: these procedures are considered not medically necessary.

DefinitionExternal charged-particle radiotherapy using protons or helium ions to target tissue

Physical principleDeposits ionizing energy at precise depths (Bragg peak) with less scatter than photon radiotherapy

Theoretical advantageAbility to deliver higher radiation dose to target while sparing adjacent normal tissues

Typical use in policy contextInvestigational approach for choroidal neovascularization from AMD (no specific CPT codes assigned)

Stereotactic radiotherapy — definition and characteristics

DefinitionNonsurgical, office-based delivery of overlapping radiation beams using a robotically controlled device

Delivery routeBeams delivered through the inferior sclera to overlap at the macula

SettingPerformed in an office setting (nonsurgical)

Clinical contextApproach considered for choroidal neovascularization from AMD but regarded as investigational/not medically necessary in this policy