Billing and Coding: Bevacizumab and biosimilars

This policy defines HCPCS coding rules for bevacizumab and its biosimilars for Part A and Part B billing, distinguishing non-ophthalmologic (systemic) dosing (report J9035 and biosimilar HCPCS codes with units as 10 mg multiples) and ophthalmologic uses (use C9257 for 0.25 mg in ASCs or the listed HCPCS codes and bill one unit per eye, with intravitreal procedure coded as CPT 67028). Dose, frequency, and off-label use must follow FDA labeling or recognized compendia; claims must include proper site modifiers (RT/LT/50) and will be denied or returned if modifiers are missing or the drug is not reasonable and necessary.

"For non-ophthalmologic (systemic) use, bevacizumab must be reported with HCPCS code J9035 (injection, bevacizumab, 10 mg) with units reflecting multiples of 10 mg provided."

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