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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.