- For CPT code J3490, the provider should include the name of the drug MacugenŽ and the number of milligrams (0.3mg) given in Item 19 of the CMS-1500 form, or the electronic equivalent.
- For CPT code 67028, use RT LT Modifiers.
- E&M service -- Modifier -25 may be used for a significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service. If modifier -25 applies to the patient scenario, on the date of the injection 67028, an evaluation and management service may be billed. Otherwise, an evaluation and management service may not be billed on the date of the service.
- MacugenŽ should be used for a single disease at this time; the disease is wet macular degeneration. MacugenŽ should be administered by sterile intraocular injection. The frequency of administration of MacugenŽ should not exceed once each six weeks.
- Documentation should include a fluorescein angiogram prior to the initial injection. After previous injections or therapy using MacugenŽ and before each subsequent treatment, a new fluorescein angiogram may be performed to establish the continued existence of wet age-related macular degeneration.
- Documentation will not be required with the submission of each claim. Provider records, for example, fluorescein angiograms, should prove the existence of wet age-related macular degeneration outlined above and be submitted upon request by the Medicare contractor.
- The fee for pegaptanib sodium may be found on our Web site under Drug Pricing in the Not Otherwise Classified (NOC) Drug Fees section, J3490, pegaptanib sodium, listed alphabetically.