Billing and Coding: Ranibizumab and biosimilars, Aflibercept, Aflibercept HD, Brolucizumab-dbll, Faricimab-svoa, PAVBLU™aflibercept-ayyh, AHZANTIVE®aflibercept-abzv. ENZEEVU™aflibercept-mrbb, OPUVIZ™aflibercept-yszy and YESAFILI™ aflibercept-jbvf

Intravitreal anti-VEGF agents and specified biosimilars (ranibizumab variants, aflibercept variants and biosimilars, brolucizumab-dbll, faricimab-svoa) are covered when used consistent with FDA-approved labeling or supported compendia/literature for off-label use. Claims must include the appropriate administration CPT code (67028 or 67027 for SUSVIMO) on the same claim as the drug, include the RT/LT/50 site modifier, and report the correct HCPCS/J- or Q-code for the drug; dosing and frequency must follow the FDA package insert unless literature support for deviations is provided.

"Intravitreal administration of ranibizumab (including ranibizumab-nuna and ranibizumab-eqrn), aflibercept (including aflibercept HD and biosimilars PAVBLU™, AHZANTIVE®, ENZEEVU™, OPUVIZ™, YESAFILI™..."

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