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2020 Cataract Episode-Based Cost Measure Specifications Retain Omidria; No Other Pass-Through Drugs Added to the Measure

This week, CMS released the measure specifications for the 2020 Cataract Episode-based Cost Measure. Unfortunately, CMS retained the pass-through drug Omidria in the measure and added its new J-code (J1097) to replace the previous C-code used to bill for the drug. ASCRS has strongly opposed the inclusion of any drug on pass-through in the episode measure because it defeats the purpose of pass-through to collect unbiased usage data on the drug for up to three years before it is included in the facility fee. While CMS did not remove Omidria from the measure, it did not add any other pass-through drug for 2020. Omidria remains the only drug on pass-through in the measure. ASCRS has continually advocated for Omidria to be removed and no additional pass-through drugs to be included and has had conversations with CMS staff. CMS has notified ASCRS that it intends to respond to our comments in detail. We will provide additional information as it becomes available.

Similar to 2019, the cost of Omidria will not impact a clinician’s cost score in 2020 if it is used on a patient with exclusionary criteria, such as a comorbidity or in conjunction with complex surgery (66982). As a reminder, only Medicare Part B patients that undergo uncomplicated cataract surgery (66984) and do not have any ocular comorbidities will be included in the measure. The list of exclusionary ocular comorbidities is identical to those of Quality measure 191, Cataracts, 20/40 or Better Visual Acuity 90 Days following Cataract Surgery. We will be following up with CMS to reiterate our opposition to including Omidria in the measure.

For complete details on the measure with all included costs and exclusionary criteria, download our 2020 Cataract Episode-Based Measure guide. If you have additional questions, please contact Allison Madson, manager of regulatory affairs, at or 703-591-2220.

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