Luxturna Subretinal Injection, Both Eyes
Luxturna is a gene therapy medication treating patients with Retinitis Pigmentosa, specifically those patients with the RPE65 Gene Mutation causing vision loss. Luxturna is delivered by injecting a genetically engineered copy of the RPE65 gene directly into the patient's retina (or both retinas) with the efficacy of improving one's vision or possibly restoring vision.
LOS ANGELES, CA 90027
The Bundled Rate plus Outlier Per Diems includes:
1. Those comprehensive facility services, supplies, and equipment necessary to perform the Bundled Procedure and rendered by PROVIDER 2. Those professional services necessary to perform the Bundled Procedure and rendered by a Physician 3. The treatment of any complication or concurrent related illness associated with or resulting from the performance of the Bundled Procedure The Bundled Rate period begins on the day of the prep regime for the scheduled Accarent Procedure and covers up to 0 inpatient days in the hospital. Should the length of stay exceed 0 inpatient days, then per diem outlier payments will be applicable for each subsequent inpatient day. Covered outpatient follow-up services related to the bundled procedure beginning on the day of infusion through 60 calendar days are included in the bundled price.
Complications or co-morbitities requiring inpatient admission are excluded from the bundled rate. Examinations and genetic testing to diagnose RPE65 gene mutation are excluded from the bundled rate. Patients under the age of 12 months are not eligible for Luxturna bundled services, but there is no upper age limit. Once member is approved and consents for Luxturna treatment, CHLA will purchase the drug. If the drug is ordered and the member cancels the procedure, CHLA will be reimbursed for Luxturna at cost. Medical services provided to member will be paid at the default rate. Luxturna does not provide clinical outcomes guaranteed to payers under a buy and bill model.
Candidacy for the bundled procedure will be determined by the Provider.