Product information and disease description Place of product in therapy Disease description Burden of Neovascular age-related macular degeneration

Economic impact of diagnostic testing

5 evidence topics · 5 sources

Medicare Physician Fee Schedule payment for OCT, OCTA, and fluorescein angiography, 2025

CPT code and procedure	2025 total RVU	2025 MPFS national average
92134 OCT of retina	“0.97”	“$31.38”
92137 OCTA of retina	“1.76”	“$56.93”
92235 Fluorescein angiography	“4.72”	“$152.68”

“CPT code 92137 has been assigned a greater total of relative value units (RVUs) and a higher Medicare Physician Fee Schedule (MPFS) payment than 92134 to account for the additional work component and practice expenses associated with performing and interpreting OCTA.” (opens the source at this quote in a new tab)
“This means that you cannot bill for more than one of those procedures when they are performed by the same clinician on the same patient on the same day.” (opens the source at this quote in a new tab)

Frequency of OCT testing: commercially insured United States population

Annual OCT test-related visits	Overall cohort	Active CNV	Inactive CNV	Inactive scar
Patients with at least 1 visit, n (%)	“5,350 (88.1)”	“3,384 (92.6)”	“893 (85.4)”	“253 (70.7)”
Number of unique visits, mean (SD)	“4.5 (3.5)”	“5.4 (3.6)”	“2.9 (2.6)”	“1.6 (1.9)”

Medicare savings from OCT-guided anti-VEGF treatment

“From 2008 – 2015, the United States government and nvAMD patients have accrued an estimated savings of $9.0 billion and $2.2 billion, respectively, from the use of OCT to guide personalized anti-VEGF treatment.” (opens the source at this quote in a new tab)

Diagnostic testing patterns in Medicare and claims populations

“In the 2008-2010 cohorts (n = 10 259), mean annual number of injections remained low (bevacizumab: 4.6, 5.1, and 5.5; ranibizumab: 6.1, 6.6, and 6.9), as did mean numbers of ophthalmologist visits (bevacizumab only) and OCT examinations (both agents), but there was no such trend in FA examinations.” (opens the source at this quote in a new tab)

Diffusion of diagnostic tests among Medicare beneficiaries in the first year after diagnosis

“A total of 23 941 Medicare beneficiaries with exudative AMD newly diagnosed during 1992-2009.” (opens the source at this quote in a new tab)
“Current Procedural Technology (CPT-4) billing codes were used to identify use of diagnostic tests (optical coherence tomography, fluorescein angiography, and fundus photography) and therapeutic interventions (argon laser photocoagulation, photodynamic therapy, intravitreal corticosteroids, and anti-vascular endothelial growth factor [VEGF] agents) used by these beneficiaries during the first year following diagnosis.” (opens the source at this quote in a new tab)
“Diffusion was rapid for each successive new diagnostic and treatment modality, with use of newer procedures quickly replacing existing ones.” (opens the source at this quote in a new tab)
“Although improving patient outcomes, rapid diffusion raises important public policy issues for Medicare and other payers to consider.” (opens the source at this quote in a new tab)