Group 1CodeDescription67028INTRAVITREAL INJECTION OF A PHARMACOLOGIC AGENT (SEPARATE PROCEDURE)J0178INJECTION, AFLIBERCEPT, 1 MG
The administration for Aflibercept must 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.
Medicare pays for an intravitreal injection (which is considered a minor surgery) as part of a global surgical package that includes the preoperative, intraoperative, and postoperative services routinely performed by the physician. Medicare pays for Eylea and Lucentis separately from the intravitreal injection.
Eylea is a drug used to treat wet age-related macular degeneration (AMD). It is also used to treat diabetic eye disease and other problems of the retina. It is injected into the eye to help slow vision loss from these and certain other diseases. Eylea is the brand name for the drug, which is called aflibercept.
(Id.). Eylea is a "buy and bill" drug, which means that physicians buy the drug in bulk and store it in their offices before prescribing and administering it to patients, filing a claim with Medicare (and, if applicable, a claim with a charity for copay assistance for the patient), and receiving reimbursements.
Ravulizumab-cwvz injection, for intravenous use (Ultomiris™) HCPCS code J3590: Billing Guidelines.
There are assistance options available for eligible patients without commercial insurance to help with the cost of EYLEA. Whether you're uninsured, your insurance doesn't cover EYLEA, or you have government-issued insurance—such as Medicare—help may be available.
HCPCS code J0178 for Injection, aflibercept, 1 mg as maintained by CMS falls under Drugs, Administered by Injection .
If your Eylea treatment is covered by Medicare Part B, you will typically be responsible for paying the Part B coinsurance or copayment (20 percent of the Medicare approved amount) after you meet the Part B deductible, which is $233 per year in 2022.
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EYLEA is the only FDA-approved treatment for DME with a recommended dose of 2 mg administered by injection in the eye every 4 weeks (approximately every 28 days, monthly) for the first 5 injections, followed by injection once every 8 weeks (2 months).
Eylea belongs to a class of drugs called Macular Degeneration Agents; Ophthalmics, VEGF Inhibitors.