Vitrectomy National Coverage Determination Update

After nearly a year of protest from ASRS, CMS issued Change Request (CR) 10859, a guidance for the Vitrectomy National Coverage Determination (NCD) 80.11 reinstating a majority of the previously deleted vitrectomy diagnosis codes effective back to their original effective dates prior to the issuance of CR 10318. 

ASRS has reviewed the deleted codes and determined that alternative diagnoses codes are available. In addition, two new ICD-10 diagnosis codes, H-35.50 and H35.53, are added to the NCD effective 1/1/19. In the case that Medicare Advantage plans continue to deny payment for vitrectomy procedures, please include a copy of CR 10859, download here.

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