NHIC Limits Avastin Use Starting Feb. 1

NHIC will allow no greater than two units for HCPCS Level II code J9035 Injection, bevacizumab, 10 mg per patient per date of service, effective for services rendered on or after Feb. 1, according to an AAPC release.

This accommodates right and left eyes being treated on the same date of service. The anticipated dosage, however, is 1.25 mg or less for ophthalmological conditions, and the smallest current available vial of bevacizumab (Avastin) contains 100 mg.

Because of the large discrepancy between vial size and dosage, providers should have the drug prepared by a compounding pharmacist to avoid significant wastage, according to the release. The recommendation on drug preparation was posted on the contractor's website by the Medicare Part B contractor for jurisdiction 14.

NHIC also reminds providers that medical necessity for J9035 is supported by disorders of the eye and adnexa ICD-9-CM diagnosis codes: 362.01-362.07, 362.15, 362.16, 362.29, 362.30, 362.35, 362.36, 362.52, 362.53, 362.83, 362.84, 364.42, 365.63, and 365.89.

Read the AAPC release on Avastin.

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