Sight Sciences Announces Fee Schedule Establishment for TearCare Dry Eye Procedure
Sight Sciences announced that two Medicare Administrative Contractors (MACs), Novitas Solutions and First Coast Service Options (FCSO), each established jurisdiction-wide pricing for CPT code 0563T (evacuation of meibomian glands, using heat delivered through wearable, open-eye eyelid treatment devices and manual expression, bilateral), which describes the procedure performed with the company’s TearCare System and related accessories. The Medicare fee schedule amount is effective for dates of service on and after January 1, 2025, in all Novitas and FCSO jurisdictions and localities.
The established local fee schedule amount for CPT code 0563T is active for claim processing and is expected to be published on the Novitas and FCSO websites for reference by eyecare providers in these areas. TearCare procedure claims will be payable by First Coast and Novitas in the areas administered by them based on individual medical necessity determinations.
The states and regions covered by these two MACS have 10.4 million in estimated total covered lives and represents approximately 30% of the total Medicare fee-for-service covered lives1.
| MAC | States / Regions Covered | Estimated Covered Lives1 |
| Novitas Solutions, Inc. | Arkansas, Colorado, District of Colombia, Delaware, Louisiana, Maryland, Mississippi, New Jersey, New Mexico, Oklahoma, Pennsylvania, and Texas | 8.0 million |
| First Coast Service Options, Inc. | Florida, Puerto Rico, Virgin Islands | 2.4 million |
“We are pleased that the rigorous TearCare review conducted by Novitas and First Coast Service Options resulted in established pricing for TearCare. We want to thank our eyecare providers, national and state societies, and Novitas and First Coast Service Options for their work to allow access to this important interventional dry eye treatment for Medicare beneficiaries in these areas when deemed medically necessary by their eyecare provider,” said Paul Badawi, Co-Founder and Chief Executive Officer of Sight Sciences. “We plan to continue to engage with third-party payors, clinical societies, and other stakeholders in continued support of patient access for the TearCare procedure.”
Sight Sciences recently launched the Sight Access Portal, which is available to provide assistance to all TearCare System, OMNI Surgical System, and SION Surgical Instrument providers with patient benefit verifications, assistance with prior authorizations, predeterminations, and any reimbursement questions.