Does J7999 require prior authorization?

No, J7999 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for J7999?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Explicit clinical documentation is required to justify any treatment frequency that is more frequent than approximately every 4 weeks in a given eye.
For Part B claims, enter 'Intravitreal bevacizumab, [dose] mg' in Item 19 of the CMS-1500 or in Loop 2300/2400 NTE01 (NTE, 02) for electronic claims.
When billing J7999, enter '1' in the days/units field for one eye or '2' if both eyes are treated in the same encounter.
When billing CPT 67028, use modifier RT or LT to indicate the eye treated; if billing bilateral use modifier 50.

When intravitreal bevacizumab is acquired from a compounding source or compounded in the physician's facility/office, bill using HCPCS J7999 on claims.
HCPCS J7999 shall be used for all compounded injectable drugs (not restricted to bevacizumab).
For Part A claims for intravitreal compounded bevacizumab, bill using HCPCS C9257 and provide the number of units.
Use scanning computerized ophthalmic diagnostic imaging (CPT 92134) at 4–6 week intervals when appropriate to evaluate need for re-treatment.
Implantable infusion pumps are covered when used to administer opioid drugs, alone or in combination with other opioid or non-opioid drugs, via the intrathecal or epidural route.
Covered for treatment of severe chronic intractable pain of malignant or nonmalignant origin when the patient has a life expectancy of at least 3 months.

PALMETTO-JJ-L33461, Implantable Infusion Pump

PALMETTO-JM-L33461, Implantable Infusion Pump

A56695, Billing and Coding: Implantable Infusion Pump

L33794, External Infusion Pumps

UHC-POL-subcutaneous-implant-naltrexone-pellets, Subcutaneous Implantable Naltrexone Pellets

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