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MP 9.03.19 Suprachoroidal Delivery of Pharmacological Agents


Medical Policy    
Original Policy Date
Last Review Status/Date
Reviewed with literature review/12:2013
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Our medical policies are designed for informational purposes only and are not an authorization, or an explanation of benefits, or a contract.  Receipt of benefits is subject to satisfaction of all terms and conditions of the coverage.  Medical technology is constantly changing, and we reserve the right to review and update our policies periodically. 


Delivery of pharmacologic agents to the suprachoroidal space is being investigated for treatment of posterior eye segment diseases.


The structure of the eye is classified under 2 subheadings: (1) anterior segment and (2) posterior segment. The anterior segment consists of the front one-third of the eye and includes the pupil, cornea, iris, ciliary body, aqueous humor, and lens; the posterior segment consists of the back two-thirds of the eye and includes the vitreous humor, retina, choroid, macula, and optic nerve. Posterior segment ocular diseases (eg, age-related macular degeneration, diabetic neuropathy) are the most prevalent causes of visual impairment. The following is a list of the various routes for ocular drug administration:

  • Invasive drug administration to intraocular cavities
    • Suprachoroidal injections
    • Intravitreal surgery
    • Intravitreal injections
    • Intracameral surgery
    • Intracameral injections
    • Subretinal injection
  • Invasive periocular and scleral modes of drug administration
    • Intrascleral surgery
    • Episcleral surgery
    • Periocular injections
    • Subconjuctival injections
    • Transscleral diffusion from controlled release systems
  • Noninvasive methods
    • Topical administration on the eye
  • Systemic administration
    • Intravenous infusion and injection
    • Oral

Many ocular diseases are treated with either topical or systemic medications. Topical application has remained the most preferred delivery route due to ease of administration. Topical application is useful in the treatment of disorders affecting the anterior segment of the eye. Although topical and systemic routes are convenient, lack of bioavailability and failure to deliver therapeutic levels of drugs to the retina has prompted vision scientists to continue to explore alternative routes of administration.

One potential advantage of suprachoroidal injection would be the ability to minimize systemic adverse effects while delivering higher local tissue levels of drugs. This proposed benefit assumes that high local levels lead to improved outcomes. Weighed against this potential benefit is the risk of localized tissue damage from the microcannula. A microcannula system combines a drug delivery channel with a fiberoptic light source for localization of the cannula tip. This technique is being investigated for the treatment of subchoroidal neovascularization related to diseases of the retina.

Regulatory Status

The iTRACK™ (iScience Interventional), which is a flexible microcannula designed to allow atraumatic cannulation of spaces in the eye for infusion and aspiration of fluids during surgery, received 510(k) marketing clearance from the U.S. Food and Drug Administration. The microcannula incorporates an optical fiber to allow transmission of light to the microcannula tip for surgical illumination and guidance. The microcannula “is indicated for fluid infusion and aspiration, as well as illumination, during surgery.”(1)


Suprachoroidal delivery of a pharmacologic agent is considered investigational. 

Policy Guidelines

Beginning January 1, 2008, there is a category III CPT code specific to suprachoroidal delivery of pharmacologic agents:
0186T: Suprachoroidal delivery of pharmacologic agent (does not include supply of medication)
The category III code was deleted 12/31/13 and CPT directs users to use code 67299- Unlisted procedure, posterior segment

Benefit Application 
BlueCard/National Account Issues 
No applicable information.

This policy was created in 2007 with the most recent literature search through November 22, 2013.

At the time this policy was created, searches of the MEDLINE database did not identify any clinical studies on the suprachoroidal delivery of pharmacologic agents. One 2007 review discussed industry-funded tests of the suprachoroidal injection technique in pig eyes.(2) Triamcinolone (3 mg) was found to remain at detectable levels in the posterior tissues of the pig eye for up to 120 days. Adverse events included infection (2 of 94), scleral ectasia (4 of 94), choroidal blood flow abnormalities (4 of 94), and inflammation (6 of 94). Some cannula tip designs resulted in snag lesions in the pigment epithelium, and the suprachoroidal space was found to separate from the sclera following injection of sodium hyaluronate but returned to a normal position after 1 month. Clinical trials in humans were reported to be ongoing.

A 2008 review by Del Amo and Urtti discussed the emerging methods of ocular drug delivery, which include polymeric-controlled release injections and implants; nanoparticulates; microencapsulated cells; iontophoresis; and gene therapy.(3) The authors note the biggest drug delivery challenge is to develop effective methods for posterior segment therapies that would also be applicable for outpatient use.

Periodic literature has identified 2 small studies from the same group of investigators. One was a prospective case series (2012) that used a microcatheter (iTRACK) for suprachoroidal drug delivery for the treatment of advanced, chronic macular edema with large subfoveal hard exudates in 6 eyes of 6 patients.(4) The subfoveal hard exudates were reported to be almost completely resolved at 1 to 2 months following a single suprachoroidal infusion of bevacizumab and triamcinolone, with no surgical or postoperative complications.

In 2012, these investigators also published an industry-sponsored retrospective analysis of 21 eyes of 21 patients with choroidal neovascularization secondary to age-related macular degeneration that were treated with bevacizumab and triamcinolone using the iTRACK microcatheter.(5) Patients were included in the analysis if they had been unresponsive to at least 3 prior treatments including thermal laser photocoagulation, photodynamic therapy, or intravitreal injections of pegaptanib, bevacizumab, or ranibizumab. Best corrected visual acuity did not improve significantly from baseline through the 6-month follow-up (0.98 logMAR [minimum angle of resolution] at baseline, 0.92 logMAR at 1 month and 0.93 logMAR at 6 months; lower scores indicate improvement). There was a significant decrease in central foveal thickness (407.2 mm at baseline to 333.3 mm at 1 month). There was no visible evidence of retinal or choroidal tissue trauma in this safety and feasibility study.


Controlled trials are needed to evaluate the safety and efficacy of suprachoroidal drug administration compared to the standard of care. Evidence to date consists of 2 small case series from the same group of investigators in Europe. Current evidence is insufficient to determine whether suprachoroidal delivery of pharmacologic agents improves the net health outcome. Thus, this procedure is considered investigational.

Medicare National Coverage

There is no national coverage determination (NCD). In the absence of an NCD, coverage decisions are left to the discretion of local Medicare carriers.



  1. U.S. Food and Drug Administration. Center for Devices and Radiological Health. Summary of Safety and Effectiveness: iScience Surgical Ophthalmic Microcannula (iTRACK) - June 22, 2004. Available online at: Last accessed November 2013.
  2. Olsen T. Drug delivery to the suprachoroidal space shows promise. Retina Today; March/April 2007. 2007. Available online at: Last accessed November 2013.
  3. Del Amo EM, Urtti A. Current and future ophthalmic drug delivery systems. A shift to the posterior segment. Drug discovery today 2008; 13(3-4):135-43.
  4. Rizzo S, Ebert FG, Bartolo ED et al. Suprachoroidal drug infusion for the treatment of severe subfoveal hard exudates. Retina (Philadelphia, Pa.) 2012; 32(4):776-84.
  5. Tetz M, Rizzo S, Augustin AJ. Safety of submacular suprachoroidal drug administration via a microcatheter: retrospective analysis of European treatment results. Ophthalmologica. Journal international d'ophtalmologie. International Journal of Ophthalmology. Zeitschrift fur Augenheilkunde 2012; 227(4):183-9.




CPT  0186T  Suprachoroidal delivery of pharmacologic agent (does not include supply of medication) (new code effective 1/1/08)
ICD-9 Procedure     
ICD-9 Diagnosis    Investigational for all codes 
HCPCS J2503 Injection, pegaptanib sodium, 0.3 mg
  J2778 Injection, ranibizumab, 0.1 mg (new code effective 1/1/08)
ICD-10-CM (effective 10/1/15)    Investigational for all diagnoses 
  H30.00-H36  Disorders of choroid and retina code range 
  H40.0-H42   Glaucoma code range 
ICD-10-PCS (effective 10/1/15)    ICD-10-PCS codes are only used for inpatient services. 
  3E0C305, 3E0C30M, 3E0C328, 3E0C329, 3E0C33Z, 3E0C3BZ, 3E0C3HZ, 3E0C3NZ, 3E0C3TZ  Administration, physiological systems and anatomical regions, eye, percutaneous, code list for various agent types 
Type of Service  Vision 
Place of Service  Physician`s Office


Suprachoroidal delivery
Choroidal neovascularization
Macular degeneration

Policy History
Date Action Reason
12/13/07 Add policy to Other section, Vision subsection New policy
10/06/09 Replace policy Policy updated with literature search for the period January 2008 through August 2009; reference number 2 added; no change in policy statement.
10/08/10 Replace policy Policy updated with literature search through August 2010; policy statement unchanged
10/04/11 Replace policy

Policy updated with literature search through July 2011; reference 3 added; policy statement unchanged


12/12/13 Replace policy Policy updated with literature search through November 22, 2013; reference 1 added, reference 2 updated, and references reordered. Policy statement unchanged.


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