May 24, 2023
Guidance for Billing Avastin for Ophthalmic Use - Correction to May 12 Communication (update to authorization requirements)
Health Partners Plans would like to provide updated guidance to our network regarding billing Avastin for Ophthalmic indications. Below you will find a grid of the accepted coding and requirements for reimbursement consideration for each.
|
Code |
Definition |
Line of Business |
Auth Required |
Medical Record Review |
|
C9257 |
Injection, bevacizumab, 0.25 mg |
Medicare |
Yes |
No |
|
C9257 |
Injection, bevacizumab, 0.25 mg |
Medicaid and CHIP |
No |
No |
|
J7999 |
Compounded drug, not otherwise classified |
Medicare |
Yes |
Yes |
|
J7999 |
Compounded drug, not otherwise classified |
Medicaid and CHIP |
Yes |
Yes |
Please note: J9035 – Injection, bevacizumab, 10 mg, is still accepted for cancer indications and will require prior authorization through eviCore for all HPP’s product lines.
If you have any questions, please contact the Provider Services Helpline at 1-888-991-9023 (Monday to Friday, 9 a.m. – 5:30 p.m.).
Thank you for your support in providing the highest quality of care to our members.
