• Medicare Carrier’s 12-State Non-Coverage Proposal of Critical Diagnostic Tools Draws Academy Ire


    The Academy is challenging a Medicare provider’s plan to deny access to effective diagnostic tools used for retina, glaucoma and other eye care patients in 12 states and two major government bodies. Novitas Solutions, Inc., is proposing to no longer cover computer-based diagnostic methods, including optical coherence tomography. We’re fighting this decision, which prevents patients from accessing technologies that ophthalmologists rely on to diagnose many eye conditions. Novitas’ coverage spans Arkansas, Colorado, Delaware, Louisiana, Maryland, Mississippi, New Mexico, New Jersey, Oklahoma, Pennsylvania, Texas and the Washington D.C. metro area, plus the Indian Health Service and the Veterans Affairs system.

    Our comments are based the Academy’s belief in the effectiveness of scanning computerized ophthalmic diagnostic imaging for advanced glaucoma. We also argue against Novitas’ decision to shun widely used definitions for glaucoma. The carrier wants to set local descriptions for mild, moderate and advanced glaucoma. We believe this will result in inaccurate coding.