How do you bill bilateral eylea?

How do you bill bilateral eylea?

Bilateral injections are billed with a -50 modifier per payer guidelines. Medicare Part B claims are billed with 67028-50 on one line, fees doubled, and 1 unit; HCPCS J-code for medication; Appropriate units administered (eg, aflibercept 2 units);

How do I bill CPT 67028?

Answer: Medicare states that you bill bilateral procedures on one line with modifier -50.

  1. 67028 -50, 1 unit and double the amount. Submit with the bilateral diagnosis.
  2. For the drug, double the units and bill the bilateral diagnosis.

What class of drug is aflibercept?

Aflibercept injection is in a class of medications called vascular endothelial growth factor-A (VEGF-A) and placental growth factor (PlGF) antagonists. It works by stopping abnormal blood vessel growth and leakage in the eye(s) that may cause vision loss in people with certain eye conditions.

How Much Does Medicare pay for J0178?

The simple answer is there is an enormous volume of payments made by the Medicare program for just 2 drugs — Lucentis (J2778) and Eylea (J0178)….Related.

J0178 Eylea 2,349,482,284
J2778 Lucentis 1,023,547,356
Various codes Avastin 83,120,791
J058x Botulinum 17,778,775

When to take Eylea for macular degeneration?

EYLEA® (aflibercept) Injection is indicated for the treatment of patients with  Neovascular (Wet) Age-related Macular Degeneration (AMD): The recommended dose is 2 mg administered by intravitreal injection every 4 weeks (monthly) for the first 12 weeks (3 months), followed by 2 mg once every 8 weeks (2 months).

What is the CPT code for Eylea injection?

Eylea ® (Aflibercept be billed on the same claim as the drug, with CPT code 67028 (intravitreal injection of a pharmacologic agent). The appropriate site modifier (RT, LT or 50) must be appended to CPT code 67028 to indicate if the service was performed unilaterally or bilaterally.

What does Eylea stand for in medical category?

Eylea (aflibercept ophthalmic solution), also known as VEGF Trap-Eye, is a fully human fusion protein, consisting of portions of Diagnosis Code Description E08.311 . Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy with macular edema .

How to ensure proper reimbursement for Eylea?

For instance, while it is anticipated that Medicare and other third-party payers will cover Eylea in due course, there was a dearth of local policies on this topic at the time of this writing. CPT coding for the administration of the drug by intravitreal injection uses 67028, the same code that is used for injecting other anti-VEGF agents.