Coding guidance Providers should bill HCPCS code J7999, which is a not otherwise classified (NOC) code, for the compounded form of Avastin administered through an intravitreal injection. Providers should bill CPT code 67028 for the intravitreal injections, in addition to the drug (s) utilized.
Full Answer
How do I Bill for Avastin (bevacizumab)?
Refer to Avastin for ophthalmological use - J7999 for correct billing of the compounded form of Avastin. When billing for Avastin (bevacizumab), please remember to verify the milligrams given to the patient and then convert to the proper units for billing as specified in the HCPCS code descriptor.
How do I Bill CPT code 67028 for one eye?
When billing CPT code 67028, modifiers RT and/or LT must be used to indicate the eye treated. Printed on 9/6/2017. Page 2 of HCPCS code C9257 is for hospital use. Provide the number of units. When billing J7999, enter '1' in the days/unit field for one eye, or "2" in the days/unit field if both eyes must be
Can I bill Medicare for Avastin and Ozurdex injections?
Since Avastin is a standard liquid injection and Ozurdex is a solid implant requiring a proprietary implantation device, it seems as though we should be able to bill this code twice as there are two separate injections, but Medicare has still denied the claims after the redetermination I submitted explained this fact.
How is intravitreal bevacizumab (ibuprofen) billed?
For Part B claims, enter "Intravitreal bevacizumab, [dose] mg" in Item 19 of CMS-1500 claim form or in Loop 2300 or 2400, NTE, 02 for electronic claims. For Part A, use HCPCS code C9257. Provide the number of units. When billing CPT code 67028, modifiers RT or LT must be used to indicate the eye treated. When billing bilateral, use modifier 50.
How do I bill for Avastin?
Providers should bill HCPCS code J7999, which is a not otherwise classified (NOC) code, for the compounded form of Avastin administered through an intravitreal injection. Providers should bill CPT code 67028 for the intravitreal injections, in addition to the drug(s) utilized.
How do I bill CPT 67028?
CPT 67028, eye modifier appended (-RT or -LT). Bilateral injections are billed with a -50 modifier per payer guidelines.
Is 67028 a bilateral code?
67028 has a bilateral indicator of 1. That means if done on each eye on the same day you should be reimbursed for both eyes.
Does Medicare pay for J codes?
J-codes are reimbursement codes used by commercial insurance plans, Medicare, Medicare Advantage, and other government payers for Medicare Part B drugs like Jelmyto that are administered by a physician.
Does Medicare cover CPT 67028?
A. CPT code 67028 (Intravitreal injection of a pharmacological agent) is the surgical procedure code. Whenever multiple surgical procedures are performed during the same session, Medicare's multiple surgery payment guidelines apply.
How often can CPT 67028 be billed?
Looking at the CPT book, 67028 can only be reported once during a defined treatment period, regardless of the number of sessions.
Does CPT 67028 need a modifier?
Because an injection in the global period is considered therapy, appending a -58 modifier to the CPT 67028 is advised.
Can 65800 and 67028 be billed together?
CPT code 67028 (Intravitreal injection of a pharmacologic agent (separate procedure)) shall not be reported with CPT codes 65800-65815 (Paracentesis of anterior chamber of the eye (separate procedure);...) when both procedures are performed on the same eye at the same patient encounter.
Does 67028 have a global period?
CPT code 67028 has a zero-day global period, meaning it is considered a minor surgical procedure by Medicare. As a general rule, evaluation and management (E/M) services performed on the same day as a minor surgical procedure are bundled into the procedure.
When do you bill J codes?
A J-code is generally used by hospitals and other medical facilities when they administer non-oral medication to a patient. For example, it can be inhalation solution, immunosuppressive drugs, and chemotherapy.
What is the difference between J3490 and J3590?
HCPCS J3490 (unclassified drug) and J3590 (unclassified biologic) are the HCPCS codes that are reported for medications that are biological but have not yet been established, to which the HCPCs code has been assigned.
How do you bill J codes by units?
The definition of the HCPCS code specifies the lowest common denominator of the amount of dosage. Use the units' field as a multiplier to arrive at the dosage amount. For example, J1756 is an injection for iron sucrose, 1 mg for a total dosage of 100 mg: report 100 in the units' field.
General Information
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
Article Guidance
Bevacizumab is not currently packaged and prepared by the manufacturer in doses appropriate for intravitreal injection. Physicians routinely obtain single doses prepared by qualified compounding pharmacies to minimize risk of contamination of the injected drug.
Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.
Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.
What is avastin used for?
Avastin® (bevacizumab), which was initially approved by the FDA in 2004 for the treatment of metastatic colon cancer, is a monoclonal antibody that binds to VEGF. Vascular endothelial growth factor (VEGF) plays an important role in both physiologic and pathologic angiogenesis and contributes to increased permeability across both the blood-retinal and blood-brain barriers. VEGF is a protein that stimulates the growth, proliferation, and survival of vascular endothelial cells. VEGF, through its promotion of angiogenesis and vascular permeability is a central component of the pathologic process driving wet age-related macular degeneration (AMD), as well as other choroidal and retinal vascular disorders.
What is Medicare Advantage Policy Guideline?
The Medicare Advantage Policy Guideline documents are generally used to support UnitedHealthcare Medicare Advantage claims processing activities and facilitate providers’ submission of accurate claims for the specified services. The document can be used as a guide to help determine applicable:
What is bevacizumab made of?
Bevacizumab is a monoclonal antibody produced by recombinant DNA technology in Chinese hamster ovaries. This monoclonal antibody binds to and inhibits the biologic activity of human vascular endothelial growth factor preventing the formation of new blood vessels.
Is bevacizumab contraindicated?
This service will be considered medically reasonable and necessary only when furnished by a qualified Ophthalmologist. Bevacizumab is contraindicated in patients with ocular or periocular infections or known hypersensitivity to bevacizumab or any of the inactive ingredients in bevacizumab.
Is Avastin a systemic drug?
Replaced language indicating “bevacizumab (Avastin®) is FDA approved for treatment of select cancers as a systemic drug” with “bevacizumab (Avastin®) is a vascular endothelial growth factor inhibitor indicated for the treatment of [the cancers listed in the policy]”
What is the HCPCS code for intravitreal injections?
Most of the medications used for intravitreal injections are assigned an HCPCS code represented with a first character of J, and so sometimes called a J-code. (There are exceptions for facility claims, which begin with C.) Each HCPCS code denotes a specific drug name, dosage, and route of administration. For example, the aflibercept (Eylea, ...
What is the J code for bevacizumab?
The options for bevacizumab coding include J9035, J3490, J3590, and J7999.
What is the J code for a single dose syringe?
When medication is compounded at a pharmacy into a single-dose syringe, many insurance carriers prefer the unlisted J-codes J3490 or J3590. When these are used, the description of the medication and dosage should be indicated in box 24a of the CMS-1500 form or EDI loop 2410.
Is J3300 injectable?
Although triamcinolone acetonide injectable suspension (J3300) has maintained a fairly consistent allowable from the first quarter of 2017 to the first quarter of 2019, aflibercept (J0178) has had a $16.84 reduction per unit over the same period. When you review the ASP file, identify the appropriate J-code for each medication, ...
