Iridex successfully appeals for revision of recent Medicare LCDs to provide broader coverage of cyclophotocoagulation

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Iridex Corp. announced its successful advocacy for revision of the recently issued Medicare Local Coverage Determinations (LCDs) for Cyclophotocoagulation (CPC).

According to the company’s news release, in recent days, the 5 Medicare Administrative Contractors (MACs) that issued the new LCDs all corrected errors in criteria for coverage of CPC resulting in broader patient qualification in the jurisdictions of these MACs.¹

”We appreciate the MACs quick action, before the Effective Date of the coverage change, to assure broader patient access to the benefits of CPC,” Iridex President and CEO David Bruce said in the company’s news release, “and that this correction was supported by strong advocacy from the original authors of the 2001 paper cited by the MACs in setting the new coverage criteria, led by Dr. Shan Lin from the Glaucoma Center of San Francisco.”

Moreover, the company noted in its news release the revised criteria aligns the LCDs with recommendations and conclusions made by authors of a 2001 paper, “Cyclophotocoagulation, A Report by the American Academy of Ophthalmology (AAO),” by mirroring several of the recommended indications.¹

Specifically, the list of patient characteristics used in the criteria, which had been separated by the word “AND,” are corrected to be separated by the word “OR” and read as follows:

Cyclophotocoagulation will be considered medically reasonable and necessary for patients with refractory glaucoma when:

1. Have failed trabeculectomy or tube shunt procedures, OR
2. Minimal useful vision and elevated intraocular pressure, OR
3. Have no visual potential and need pain relief.

Bruce added that while the company is pleased with this first step to enhance coverage, it is preparing another appeal to further broaden the patient criteria qualifying for reimbursement in these MAC jurisdictions.

“We will urge MAC administrators to include the additional recommendations from the 2001 AAO paper that remain excluded from the current modified LCD to cover (i) patients that are poor candidates for invasive surgical procedures and (ii) emergency situations,” Bruce said in the news release. “Our appeal will also seek proper consideration of the technological advances and the large body of peer-reviewed clinical studies supporting a broad range of patient types, disease severities, and safety evidence for CPC during the 22 years since the AAO paper and further broaden patient indications for coverage.”

Reference:

1. Corporation I. Iridex Corporation Announces Successful Appeal for Revision of Recent Medicare LCDs to Provide Broader Coverage of Cyclophotocoagulation. GlobeNewswire News Room. Published November 27, 2023. Accessed November 28, 2023. https://www.globenewswire.com/news-release/2023/11/27/2786204/0/en/Iridex-Corporation-Announces-Successful-Appeal-for-Revision-of-Recent-Medicare-LCDs-to-Provide-Broader-Coverage-of-Cyclophotocoagulation.html

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