Billing and Coding: Aflibercept (EYLEA®)

Aflibercept (EYLEA) is FDA‑approved and covered for intravitreal treatment of neovascular (wet) AMD, macular edema following RVO, diabetic macular edema, and diabetic retinopathy using indication‑specific dosing regimens (doses 2 mg/0.05 mL with loading and maintenance intervals as specified). Claims must be submitted on CMS Form 1500 with the appropriate HCPCS/J‑code and CPT 67028; if different anti‑VEGF agents are given in each eye on the same date, document clinical rationale and append the correct RT/LT modifiers. Routine dosing more frequently than every 8 weeks after the loading period has not shown additional efficacy for most patients, though some patients may require monthly dosing per clinical judgment.

"Aflibercept (EYLEA) is FDA‑approved for treatment of neovascular (wet) age‑related macular degeneration (AMD) by intravitreal injection."

Sign up to see full coverage criteria, indications, and limitations.