Billing and Coding: Intraocular Bevacizumab

Noridian requires HCPCS J7999 (or C9257 for Part A) when billing for compounded intravitreal bevacizumab and disallows use of J3590 for these claims effective 1/1/2016. Billing must include specific claim text/fields (CMS-1500 Item 19 or electronic NTE), appropriate modifiers (RT/LT or 50; days/units = 1 or 2 for J7999), and physicians must document informed consent and medical necessity; imaging (CPT 92134) is appropriate every 4–6 weeks to assess retreatment. Treatments more frequent than approximately every 4 weeks per eye are expected to be rare and require explicit documentation, and use of both scanning laser and fundus photography is bundled under NCCI and requires documentation of medical necessity.

"When intravitreal bevacizumab is acquired from a compounding source or compounded in the physician's facility/office, bill using HCPCS J7999 on claims."

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