CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Transpupillary Thermotherapy for Treatment of Choroidal Neovascularization

Defines coverage determination for transpupillary thermotherapy (TTT) when used to treat choroidal neovascularization (CNV), specifying Medicare Advantage and commercial product stances and billing guidance for reporting the procedure.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyTranspupillary Thermotherapy for Treatment of Choroidal Neovascularization

Policy CodePolicy N/A

Change TypeClarified coverage stance

Effective DateFeb 17, 2009

Next Review Date

Key ActionClaims for TTT to treat choroidal neovascularization are not covered for Medicare Advantage members and are not medically necessary for commercial products; reimbursement may be denied.

POLICY UPDATE CHANGES

Policy states TTT for CNV is not covered for Medicare Advantage and not medically necessary for commercial products due to insufficient evidence.

1Coverage stance - Medicare Advantage

1Coverage stance - Commercial

1Recommended reporting code (unlisted)

Coverage Summary

Defines coverage determination for transpupillary thermotherapy (TTT) when used to treat choroidal neovascularization (CNV), specifying stances for Medicare Advantage and Commercial products. The policy effective date is 02/17/2009 and the last review date is 03/18/2026.

Coverage stance: Not covered / not medically necessary (cosmetic). For Medicare Advantage, TTT for CNV is not covered because the evidence is insufficient to determine effects on health outcomes. For Commercial products, TTT for CNV is not medically necessary for the same reason.

Medical-Necessity / Coverage Determination

Coverage Determination

Coverage statements for TTT to treat CNV:

ALL of the following

Medicare Advantage Plans: Transpupillary thermotherapy for the treatment of choroidal neovascularization is not covered as the evidence is insufficient to determine the effects of the technology on health outcomes.
Commercial Products: Transpupillary thermotherapy for the treatment of choroidal neovascularization is not medically necessary as the evidence is insufficient to determine the effects of the technology on health outcomes.

Coding Guidance

Recommended reporting codeCPT

67299

Unlisted procedure, posterior segment (to report transpupillary thermotherapy)

Incorrectly reported code (do not use)CPTNot Covered

67220

Incorrect to report this service with CPT code 67220

Billing Rule

Do not use CPT 67220

Do not report transpupillary thermotherapy with CPT code 67220. Report the service using unlisted procedure, posterior segment: 67299.

67299
67220

Provider Actions & Reimbursement Impact

Denial Risk

Service considered not covered / not medically necessary

Claims for transpupillary thermotherapy (TTT) to treat choroidal neovascularization (CNV) are not covered for Medicare Advantage members and are not medically necessary for Commercial products. Reimbursement for this service may be denied.

Refer to coding guidance (use 67299; do not use 67220) for reporting if applicable

Background & Evidence Summary

Transpupillary thermotherapy (TTT) is a technique delivering low-level heat through the pupil using a modified diode laser to gently heat subfoveal choroidal lesions while limiting damage to the overlying retinal pigment epithelium. TTT uses lower power over more prolonged periods compared with standard photocoagulation, aiming to treat choroidal lesions with reduced retinal pigment epithelium injury.

Randomized trials versus sham: Available studies comparing TTT with sham have not shown a benefit.

Comparisons to photodynamic therapy: Trials report similar outcomes between TTT and photodynamic therapy, although there may be an increase in adverse events with TTT.

Comparisons to angiogenesis inhibitors: No direct comparisons of TTT with angiogenesis inhibitors have been reported; evidence is insufficient to determine comparative benefit.

Definitions

Transpupillary thermotherapy (TTT)A technique delivering low-level heat through the pupil using a modified diode laser to heat choroidal lesions while limiting damage to the overlying retinal pigment epithelium.

Choroidal neovascularization (CNV)Neovascular membranes beneath the retina often associated with wet age-related macular degeneration, increasing risk of severe irreversible vision loss.

Revision History

2009-02-17policy_effective