Reimbursement for compounded Avastin eye injections changing in August for Medicare Advantage members

For claims received on or after Aug. 1, 2022, reimbursement will change to $160 per eye injected with compounded Avastin^® (bevacizumab) eye injections for Medicare Plus Blue℠ and BCN Advantage℠ members.

This change for medical drug claims for Medicare Plus Blue and BCN Advantage members aligns with reimbursement in the marketplace. It’s based on clinical trials that demonstrate the product’s safety and effectiveness.

Here’s the information to include on the claim:

• HCPCS code number
• For Medicare Plus Blue: J3590
• For BCN Advantage: J9035
• National Drug Code
• NDC units (example: 0.05 ml)
• Exact dose in milligrams (example: 1.25 mg)
• Specific ICD codes pertinent to eye disease

Note: Avastin eye injections don’t require authorization.