Intraocular Radiotherapy for Age-Related Macular Degeneration
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This policy governs coverage determinations for intraocular radiation therapies (epiretinal/brachytherapy, proton beam, stereotactic radiotherapy) for choroidal neovascularization due to age-related macular degeneration for Capital Blue Cross products (with product-specific variations noted).
No material clinical or coverage changes in this revision.
Coverage Criteria
Policy stance on intraocular radiotherapy
Covered when ALL of the following are met
ALL of the following
ONE of the following intraocular radiotherapy modalities
- Epiretinal or intraocular brachytherapy (intraocular placement of a radiation source) is being considered.
- Proton beam therapy is being considered.
- Stereotactic radiotherapy is being considered.
- There is robust clinical evidence demonstrating improvement in net health outcomes (e.g., visual acuity, functional outcomes, or quality of life) for the proposed procedure compared with standard care.
- Available randomized controlled trial data do not show increased harms that outweigh benefits for the proposed procedure compared with standard care.
- The request and clinical documentation demonstrate that standard, accepted care (including intravitreal anti-VEGF therapy when indicated) has been considered or attempted as appropriate prior management.
- The procedure is billed using an approved, covered procedure code (note: unlisted procedure code 67299 is identified in this policy as investigational and therefore not covered).
This policy addresses intraocular radiation therapies for choroidal neovascularization due to age-related macular degeneration, including (1) intraocular placement of a radiation source (brachytherapy), (2) proton beam therapy, and (3) stereotactic radiotherapy. These interventions are described in the policy as investigational for treatment of CNV and are the focus of the coverage determination for Capital Bluecross products.
The available evidence is summarized in randomized trials, systematic reviews, and smaller studies for each modality. For brachytherapy, RCTs comparing brachytherapy plus anti-VEGF versus anti-VEGF monotherapy did not demonstrate noninferiority for visual acuity and reported higher proportions of adverse events. Proton beam trials were limited (including a halted randomized trial) and did not show statistically significant stabilization of vision. Stereotactic radiotherapy reduced the number of anti-VEGF injections in one RCT but did not produce significant improvements in visual acuity versus control. Overall, the evidence is insufficient to determine an improvement in net health outcome for these procedures.
Administrative updates to the policy removed the Benefit Variations section; the document no longer lists product-specific benefit exceptions. The policy text does not present additional explicit clinical exclusions beyond the investigational designation for these intraocular radiation procedures, so providers should verify member-specific benefits and prior authorization requirements with the payer.
Coding and Billing
| 67299 | Unlisted procedure, retina or choroid (listed as investigational, therefore not covered) |
Provider Actions and Prior Authorization
Verify product applicability and coding (prior auth may be affected)
This policy notes product-specific applicability and that coding lists may not be exhaustive; investigational procedures (example listed: CPT 67299) are identified as not covered and may affect prior authorization determinations.
- Policy applies only to certain programs and products and is subject to benefit variations.
- Coding information section states the code list may not be all-inclusive; codes are subject to change.
- Procedure code 67299 is listed as investigational and therefore not covered.
Confirm member benefits and prior authorization requirements
Policy history documents administrative updates and removal of the Benefit Variations section; providers must verify member-specific benefits and prior authorization requirements with the payer before requesting services.
- Administrative update removed Benefit Variations section (09/24/2025).
- Contact Provider Services or Member Services for questions about applicability to a member's benefit program.
Use anti-VEGF intravitreal therapy as usual care before investigational radiotherapy
Standard care for neovascular AMD is intravitreal anti-VEGF agents; intraocular radiotherapy (brachytherapy, proton beam, stereotactic radiotherapy) is described as an investigational alternative under study and not as first-line therapy.
- Usual care includes intravitreal agents targeting VEGF (pegaptanib, ranibizumab, bevacizumab, aflibercept).
- Intraocular radiation approaches are being investigated as alternatives when repeated injections are required.
Consider cited AAO/NICE guidance; policy contains no explicit step-therapy mandate
Guideline and regulatory references (AAO Preferred Practice Pattern, NICE IPG415) are cited in the policy and may inform clinical decision-making, but the policy does not impose an explicit step-therapy requirement.
- AAO Preferred Practice Pattern for Age-Related Macular Degeneration is referenced.
- NICE epiretinal brachytherapy guidance (IPG415) is listed among references.
- No explicit step therapy rule is stated in the policy.
Verify member benefits and contact Provider/Member Services for questions
Providers must verify member benefits and eligibility on the date of service; for questions regarding coverage or applicability of this policy to a member, contact Capital Blue Cross Provider Services or Member Services.
- Coverage is subject to the member's benefit program and eligibility on the date of service.
- Contact Provider Services or Member Services for questions about member-specific benefits.
Provide cited clinical trial and guideline references when requesting coverage
Include cited clinical trial publications and guideline references from the policy (e.g., MERLOT, CABERNET, INTREPID, AAO Preferred Practice Pattern) to support clinical rationale when requesting coverage or prior authorization.
- Randomized trials and study publications are listed (MERLOT, CABERNET, MERITAGE, INTREPID, etc.).
- Guideline references (AAO Preferred Practice Pattern, NICE) are provided in the reference list.
Do not expect coverage for investigational intraocular radiotherapy; claims may be denied
Procedures for intraocular placement of a radiation source (brachytherapy), proton beam therapy, and stereotactic radiotherapy are considered investigational and therefore not covered; claims billed with investigational procedure codes (example: CPT 67299) risk denial.
- Policy explicitly lists intraocular brachytherapy, proton beam therapy, and stereotactic radiotherapy as investigational and not covered.
- Procedure code 67299 is listed under 'Investigational, therefore not covered' and may trigger claim denial.
Administrative update: Benefit Variations removed — verify effects on member determinations
The Benefit Variations section was removed in an administrative update; providers should consider that removal when making member-level coverage and prior authorization determinations and verify eligibility and benefit details with the payer.
- Administrative Update 09/24/2025: Removed Benefit Variations section and updated disclaimer.
- Absence of the Benefit Variations section may affect product-specific coverage interpretations—verify member-level benefits.
Background
Age-related macular degeneration (AMD) is a leading cause of vision loss in older adults. The neovascular or “wet” form involves choroidal neovascularization (CNV), which can cause rapid and severe central vision decline. Standard management for neovascular AMD is intravitreal anti-VEGF therapy. Epiretinal or intraocular radiation approaches (for example, surgical epiretinal brachytherapy delivering a focal beta radiation dose, proton beam therapy, or stereotactic radiotherapy) have been investigated as alternatives or adjuncts to reduce injection frequency or treat refractory CNV, but clinical trials have not demonstrated consistent visual acuity benefit compared with standard therapy.
Definitions
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