Does J2503 require prior authorization?

No, J2503 does not require prior authorization (high confidence). Code is covered without prior authorization.

`J2503`, Injection, pegaptanib sodium, 0.3 mg

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

No explicit Medicare/coverage-specific documentation requirements are stated in this document.
For IMT: Documentation of evidence of a visually significant cataract (grade 2 or higher).
"Visual acuity poorer than 20/160, but not worse than 20/800 in both eyes;"
"Willingness to participate in a post-operative visual rehabilitation program."

Use of any of the following therapies for treatment of neovascular (wet) age-related macular degeneration (ARMD): Aflibercept (Eylea) injection (CPB 0701 - Vascular Endothelial Growth Factor Inhibitors for Ocular Indications).
Use of any of the following therapies for treatment of neovascular (wet) age-related macular degeneration (ARMD): Bevacizumab (Avastin) injection (CPB 0685 - Bevacizumab for Non-Ocular Indications).
Use of any of the following therapies for treatment of neovascular (wet) age-related macular degeneration (ARMD): Pegaptanib sodium (Macugen) injection (CPB 0701 - Vascular Endothelial Growth Factor Inhibitors for Ocular Indications).
Use of any of the following therapies for treatment of neovascular (wet) age-related macular degeneration (ARMD): Photodynamic therapy (PDT) with light-activated verteporfin (CPB 0594 - Visudyne (Verteporfin) Photodynamic Therapy).
Use of any of the following therapies for treatment of neovascular (wet) age-related macular degeneration (ARMD): Ranibizumab (Lucentis) injection (CPB 0701 - Vascular Endothelial Growth Factor Inhibitors for Ocular Indications).
Use of any of the following therapies for treatment of neovascular (wet) age-related macular degeneration (ARMD): Brolucizumab (Beovu) injection (CPB 0701 - Vascular Endothelial Growth Factor Inhibitors for Ocular Indications).

AETNA-CPB-0484, Glaucoma Surgery

AETNA-CPB-0765, Age-Related Macular Degeneration

BCBSIL-OTH903.015, Photodynamic Therapy for Choroidal Neovascularization

BCBSMT-OTH903.015, Photodynamic Therapy for Choroidal Neovascularization

BCBSNM-OTH903.015, Photodynamic Therapy for Choroidal Neovascularization

Ask Verity about documentation requirements, denial risks, or coverage in your state.