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The structure of the eye is classified under two subheadings: (1) anterior segment and (2) posterior segment. The anterior segment consists of the front one-third of the eye that includes; pupil, cornea, iris, ciliary body, aqueous humor, and lens; the posterior segment consists of the back two-thirds of the eye that includes vitreous humor, retina, choroid, macula, and optic nerve. Posterior segment ocular diseases (e.g., age-related macular degeneration, diabetic neuropathy) are the most prevalent causes of visual impairment. The following is a list of the various routes for ocular drug administration:

• Invasive drug administration to intraocular cavities
  
  • Suprachoroidal injections
  • Intravitreal surgery
  • Intravitreal injections
  • Intracameral surgery
  • Subretinal injection
  • Intracameral injections
• Invasive periocular and scleral modes of drug administration
  
  • Intrascleral surgery
  • Episcleral surgery
  • Periocular injections
  • Subconjuctival injections
  • Transscleral diffusion from controlled release systems
    
• Noninvasive methods
  
  • Topical administration on the eye
    
• Systemic administration
  
  • Intravenous infusion and injection
  • Oral

Many ocular diseases are treated with either topical or systemic medications. Topical application has remained the most preferred delivery route due to ease of administration. Topical application is useful in the treatment of disorders affecting the anterior segment of the eye. Although topical and systemic routes are convenient, lack of bioavailability and failure to deliver therapeutic levels of drugs to the retina has prompted vision scientists to continue to explore alternative routes of administration.

One potential advantage of suprachoroidal injection would be the ability to minimize systemic side effects while delivering higher local tissue levels of drugs. This proposed benefit assumes that high local levels lead to improved outcomes. Weighed against this potential benefit is the risk of localized tissue damage from the microcannula. A microcannula system combines a drug delivery channel with a fiberoptic light source for localization of the cannula tip. This technique is being investigated for the treatment of subchoroidal neovascularization related to diseases of the retina.

The iTrack™ (iScience Interventional), which is a flexible microcannula designed to allow atraumatic cannulation of spaces in the eye for infusion and aspiration of fluids during surgery, received 510(k) marketing clearance from the U.S. Food and Drug Administration (FDA). The microcannula incorporates an optical fiber to allow transmission of light to the microcannula tip for surgical illumination and guidance. The microcannula “is indicated for fluid infusion and aspiration, as well as illumination, during surgery.”

Other currently used and proposed treatments for CNV are addressed in Transpupillary Thermotherapy for Treatment of Choroidal Neovascularization.  

The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.

3/27/2008: Reviewed and approved by the Medical Policy Advisory Committee (MPAC)

04/19/2010: Policy description rewritten extensively regarding treatment approaches. Policy statement unchanged. FEP verbiage added to the Policy Exceptions section.

12/30/2010:  Policy reviewed; no changes.

12/01/2011:  Policy reviewed; no changes.

04/03/2013:  Policy reviewed; no changes.

All codes billed for this procedure are considered investigational and not eligible for coverage. 

Non-Covered Codes

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