May 24, 2023

Guidance for Billing Avastin for Ophthalmic Use - Correction to May 12 Communication (update to authorization requirements)

Health Partners Plans would like to provide updated guidance to our network regarding billing Avastin for Ophthalmic indications. Below you will find a grid of the accepted coding and requirements for reimbursement consideration for each.

Code	Definition	Line of Business	Auth Required	Medical Record Review
C9257	Injection, bevacizumab, 0.25 mg	Medicare	Yes	No
C9257	Injection, bevacizumab, 0.25 mg	Medicaid and CHIP	No	No
J7999	Compounded drug, not otherwise classified	Medicare	Yes	Yes
J7999	Compounded drug, not otherwise classified	Medicaid and CHIP	Yes	Yes

Please note: J9035 – Injection, bevacizumab, 10 mg, is still accepted for cancer indications and will require prior authorization through eviCore for all HPP’s product lines.

If you have any questions, please contact the Provider Services Helpline at 1-888-991-9023 (Monday to Friday, 9 a.m. – 5:30 p.m.).

Thank you for your support in providing the highest quality of care to our members.

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Guidance for Billing Avastin for Ophthalmic Use - Correction to May 12 Communication (update to authorization requirements)