Lucentis gets its own permanent J code: J2778

Why This Topic Matters

It helps practices understand a new drug coding change, align claim submission timing and units, and anticipate payer-related implementation issues for a high-cost ophthalmic therapy.

Article Sections

1. Lucentis J code implementation

   Introduces the new CMS drug code and the transition away from prior unlisted-code reporting for Lucentis. It also addresses timing and practice workflow considerations for implementing the change.

2. Payer mix and communication issues

   Reviews the distribution of payer types for age-related macular degeneration and why coordination with commercial insurers matters. The section highlights reimbursement administration concerns for practices serving Medicare and mixed-payer patients.

3. Coverage, reimbursement support, and related CMS commentary

   Discusses broader reimbursement challenges for an expensive ophthalmic drug and references manufacturer support resources. It also notes CMS commentary related to bevacizumab and potential supply-related policy considerations.