Coverage of Bevacizumab (Avastin™) for Age-Related Macular Degeneration Recent articles in the journal RETINA (Volume 28, Number 3, March 2006) and Ophthalmology (Volume 113, Number 3, March 2006) have provided scientific support that may indicate that bevacizumab (Avastin™) is effective when administered as an intravitreal injection in the short-term treatment of wet age-related macular degeneration (AMD). Based on this information, Empire Medicare Services (EMS) will cover bevacizumab for treatment of wet age-related macular degeneration, effective for dates of service on or after June 1, 2006. The claim for the intravitreal injection should be coded using CPT code 67028 (intravitreal injection of pharmacologic agent (separate procedure)), with the appropriate site modifier (RT, LT or -50 (bilateral procedure)). The only payable diagnosis code for this treatment is ICD-9-CM code 362.52 (exudative senile macular degeneration; wet). The injection (CPT 67028) and the bevacizumab (HCPCS code J9035) must be billed on the same claim. |
