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Alcon Announces CyPass® Micro-Stent’s Unique Procedure Code Becomes Effective, Paving the Way for Medicare Reimbursement

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Alcon, the global leader in eye care and a division of Novartis, announces that the unique Current Procedural Terminology (CPT) code 0474T issued by American Medical Association (AMA) for the newly launched CyPass® Micro-Stent is now effective. In addition, the device has received positive feedback related to coverage and payment from all U.S. Medicare Administrative Contractors (MACs) and several major commercial payers. The CyPass® Micro-Stent is a minimally invasive glaucoma surgical (MIGS) device that treats adult patients with mild to moderate primary open-angle glaucoma in conjunction with cataract surgery.

“The positive response from the payer community makes it possible for millions of patients living with cataracts and glaucoma to access Alcon’s unique MIGS technology,” said Nancy Tuffin, Head, Government Policy and U.S. Reimbursement, Alcon. “The CyPass® Micro-Stent offers a less invasive means of lowering IOP than traditional glaucoma surgery, with the goal of lowering the patient’s dependence on topical glaucoma medication. We are excited that surgeons and the patients they serve now have greater coverage from Medicare and commercial payers.”

The new CPT code became effective July 1, 2017 after a six-month implementation period. It is a Category 3 code, similar to those assigned to other emerging technologies. The positive feedback from the MACs means that the CyPass® Micro-Stent will be covered by Medicare in all 50 states. This extends coverage for the device to qualifying patients among the 40 million people who are covered by Medicare. In addition, the CyPass® Micro-Stent is now included in leading national commercial payers’ plans, ensuring coverage for qualifying patients among the 55 million people covered by those plans. 

About Glaucoma

More than 60 million people globally are affected by glaucoma that can lead to progressive damage of the optic nerve. Early diagnosis of glaucoma is critical to manage the disease, as it is often asymptomatic and therefore can go undetected until it is at an advanced stage. As the disease progresses, patients may experience loss of peripheral (side) vision, tunnel vision or eye spots. Glaucoma can eventually result in gradual, irreversible loss of vision and blindness. The exact cause of glaucoma is unknown. However, elevated pressure in the eye (intraocular pressure, or IOP) is generally present with glaucoma and is the only known modifiable risk factor. As a chronic disease, patients can be treated with eye drops, oral medications, laser surgery, traditional surgery or a combination of these methods.1-3

About the CyPass Micro-Stent

The CyPass Micro-Stent is a prescription medical device that is indicated for use in conjunction with cataract surgery for the reduction of IOP in adult patients with mild to moderate primary open-angle glaucoma. The use of the CyPass Micro-Stent is contraindicated in eyes with angle closure glaucoma and eyes with traumatic, malignant, uveitic or neovascular glaucoma or discernible congenital anomalies of the anterior chamber angle. If IOP is not adequately maintained after implantation of a CyPass Micro-Stent, additional therapy may be needed for IOP control.

In a randomized, multicenter clinical trial comparing cataract surgery with CyPass to cataract surgery alone, the most common post-operative adverse events included: Best Corrected Visual Acuity (BCVA) loss of 10 or more letters at 3 months after surgery (8.8% for CyPass vs. 15.3% for cataract surgery only); anterior chamber cell and flare requiring steroid treatment 30 or more days after surgery (8.6% vs. 3.8%); worsening of visual field mean deviation by 2.5 or more decibels (6.7% vs. 9.9%); IOP increase of 10 or more mmHg 30 or more days after surgery (4.3% vs. 2.3%); and corneal edema 30 or more days after surgery, or severe in nature (3.5% vs. 1.5%). Please refer to the Instructions for Use for the CyPass Micro-Stent for a complete list of contraindications, warnings, precautions and adverse events.

For more information, visit www.Alcon.com.

 

References

  1. Lighthouse International. Prevalence of Vision Impairment. http://www.lighthouse.org/research/statistics-on-vision-impairment/prevalence-of-vision-impairment/(link is external).
  2. Quigley and Broman. The Number of People with Glaucoma Worldwide in 2010 and 2020. Br J Ophthalmol 2006;90:262-7.
  3. http://myeyes.com/glaucoma.shtml(link is external)