How to code for Lucentis and Avastin

Why This Topic Matters

Drug billing for ophthalmic therapy can vary by payer, product, and coverage status, so understanding the article helps practices align claims handling with carrier expectations and avoid payment problems. It also touches on compliance concerns related to off-label treatment and informed consent.

Article Sections

1. Billing and reimbursement considerations

   Introduces the practical billing issues discussed in the article, including payer preference, reimbursement, and the differences in how the drugs are handled by carriers.

2. Clinical and coverage context

   Summarizes the clinical setting for the drugs and describes the broader coverage environment, including off-label and on-label use considerations.

3. Consent for off-label use

   Addresses patient consent considerations when a drug is used outside its approved indication.

4. Medicare payment and carrier guidance

   Reviews the Medicare coverage environment and notes the presence of carrier-specific guidance relevant to billing.