decisionhealth Newsletters, Coder Pink Sheets - 2007 Issue 11 (November)
No more compounded Avastin
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Article Overview
This article covers an ophthalmology reimbursement and drug-access update centered on the use of Avastin and Lucentis in age-related macular degeneration and related eye conditions. It explains why the topic matters to physicians, billing staff, and Medicare-reimbursed practices, and it discusses general coding and billing changes, drug availability, compounding-pharmacy issues, and an expected HCPCS update for Lucentis.
Why This Topic Matters
The article affects how eye-care practices manage drug sourcing, billing, and reimbursement for intravitreal therapy, especially when compounded Avastin is no longer available through prior channels. It is relevant to practices tracking Medicare billing, HCPCS updates, and treatment access for retinal disease.
Article Sections
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Compounded Avastin access and ophthalmology billing concerns
Discusses changes affecting access to Avastin for ocular use and the resulting implications for billing, drug sourcing, and practice operations. It also references related oversight and specialty-society response.
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New J code for Lucentis
Covers an expected HCPCS coding update for Lucentis and the timing of the new assignment. It notes that the article is addressing a pending reimbursement change rather than a full coding policy review.
What You Will Learn
- How Avastin access changes may affect ophthalmology practice workflows
- Why billing and reimbursement concerns arose around off-label ocular drug use
- What broad coding update was expected for Lucentis
- How drug availability issues can influence patient care and payment planning
Who Should Read This
- Ophthalmologists
- Retina specialists
- Medical coders
- Billing staff
- Practice administrators
- Reimbursement professionals
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