• Documentation Posted Confirming Vitrectomy Coverage Fix

    The Centers for Medicare & Medicaid Services notified the Academy this week that it took an important step to formally address an issue we raised involving national coverage decisions for vitrectomy procedures. An agency representative this week posted an updated policy reinstating previously deleted vitrectomy codes. If you experience any vitrectomy coverage denials from Medicare Advantage plans, the Academy urges you to forward the information to HealthPolicy@aao.org or cmcnett@aao.org

    The policy change clearly states that CMS halted the previous deletion of diagnoses codes associated with this procedure. This reverts the policy back to previous coverage while the agency reviews the list of deleted codes. 

    The Academy expects all Medicare administrative contractors to post similar language soon. 

    CMS’ move was expected, in line with what the agency told the Academy in January. At that time, CMS said it would instruct its contractors to restore recently eliminated diagnosis codes associated. 

    The Academy led a successful effort to reverse this deletion, which took place in October. 

    We took action when CMS authorized deletion of nearly 25 percent of vitrectomy’s diagnosis codes. These included those for vitreous hemorrhage, macular hole and macular pucker. The deletions were part of an effort to clean up its volume of ICD-10 codes associated with national coverage decisions. 

    Still, the sheer number of diagnoses deleted was a shocking and perplexing development. The Academy remains diligent in efforts to ensure continued access to procedures often done on an emergency basis.