Program_Memos / 2001 / AB-01-90

Why This Topic Matters

The memorandum clarifies how a newly introduced ophthalmic treatment was handled in Medicare claims during a period of changing payment rules. It matters because it ties clinical service reporting, drug reporting, and setting-specific billing together under official program instructions.

Article Sections

1. Program Memorandum Background

   Introduces the memorandum, its transmittal information, and the relationship to the earlier version it reissues. Provides administrative context and dates.

2. Subject: Ocular Photodynamic Therapy (OPT)

   Summarizes the therapy addressed by the memo and its connection to age-related macular degeneration and the approved drug discussed in the guidance.

3. Medicare Coverage and Payment Guidance

   Discusses the Medicare coverage framework, carrier and intermediary responsibility, and general payment treatment for the therapy and associated services.

4. Claims Processing and Outpatient PPS Transition

   Describes how claims were to be handled before and after the outpatient prospective payment system transition, including the related reporting approach for the therapy and drug.

5. Experimental Services and Administrative Dates

   Notes which related procedures were treated as experimental in the memorandum and lists the effective, implementation, and discard dates.