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iv.         for each repeat therapy, recurrent or persistent CNV leakage is detected by fluorescein angiography and documented by retinal photographs retained on the patient's permanent medical record.

If the patient's clinical condition meets all the above criteria but retinal photographs are not made prior to the procedure and retained on the patient's permanent medical record or the procedure is not performed by an ophthalmologist, then PDT is an insured service payable at nil.  Maximum one PDT (unilateral or bilateral) per patient per day.

G460  -   unilateral PDT per patient per day ........................$300.00
G461  -   bilateral PDT per patient per day ...........................$375.00

Note:

1.      G379 rendered to same patient in conjunction with G460 or G461 is an insured service payable at nil.

2.      G460 rendered to same patient same day as G461 is an insured service payable at nil.

3.      Assessments and angiography are payable in addition to PDT. Retinal photography is insured as a specific 
   element of the assessment and is not payable separately.

Commentary:

 1.      The above fees for PDT have been introduced on an interim basis and will be subject to a joint review by the 
          Ministry and the Ontario Medical Association on or before March 31, 2003.

2.      PDT will normally not be administered to each affected eye more frequently than once every 3 months. 

3.      PDT performed for treatment of clinical conditions other than described above is uninsured.

The heading of Consultations and Visits listings for Ophthalmology (23) will be amended on June 15, 2002 to include a note on page A32 to the effect:

"Note: Ophthalmology consultations and visits may include retinal photography as a specific element of the insured service, where medically indicated."

Publicly Funded Verteporfin

The Ministry of Health and Long-Term Care will fully cover the verteporfin drug used in performing PDT on eligible patients.   The Priority Programs Unit, Hospitals Branch, Health Care Programs Division will manage the funding of the drug.

In 2002/03, the Ministry of Health and Long-Term Care will designate up to eight public hospitals across Ontario to monitor verteporfin usage by designated ophthalmologists.  The designated hospitals are: London Health Sciences Centre - Ivey Eye Clinic, Hamilton Health Sciences Corporation, William Osler - Peel Memorial, University Health Network - Western Division, Sunnybrook and Women's College HSC, The Ottawa Hospital, Kingston Hotel Dieu and Sudbury Regional Hospital. These hospitals will also receive, gather and submit relevant supporting information to the ministry on a monthly basis for funding reconciliation.

The drug and kit will be distributed by the Ontario Government Pharmacy based on orders backed up by a Patient Registration Form received from the aforementioned hospitals as directed by ophthalmologists who have registered as authorized providers with the Priority Programs Unit.


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