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CPT codes

Marina Posted Mon 18th of May, 2015 18:06:04 PM

What CPT code should be used for Optic Disk Photography? Also, what codes do I use to bill for:
1) Avastin
2) Lucenetis
3) Eylea

SuperCoder Answered Tue 19th of May, 2015 00:33:08 AM

Use CPT code 92250 (Fundus photography with interpretation and report). Fundus Photography include photograph of the interior surface of the eye, including the retina, optic disc, macula, and posterior pole (i.e. the fundus).
For Avastin Drug, use HCPCS J9035.
For Lucentis, use HCPCS J2778.
For Eylea, use HCPCS J0178.

Marina Posted Tue 19th of May, 2015 12:08:43 PM

Thank you

SuperCoder Answered Wed 20th of May, 2015 00:29:39 AM

Happy to Help.

Marina Posted Wed 20th of May, 2015 12:36:25 PM

One last question please: How can I find the Medicare reimbursement rates for the HCPCS codes listed above?

SuperCoder Answered Thu 21st of May, 2015 00:40:27 AM

These HCPCS codes are Drug supply codes and provider should bill the cost of 1 complete vial and if not used complete vial, providers must discard the vial after treating one patient. Please bill the cost of total vial used.

Marina Posted Thu 21st of May, 2015 12:02:37 PM

Do insurance companies (mainly Medicare)reimburse for full amount of vial?

SuperCoder Answered Fri 22nd of May, 2015 01:14:47 AM

It depends upon Insurance company to company. Usually Medicare reimburse full amount of vial and keep a condition to discard the left drug. For example: Eylea is listed in the Medicare NOC (not otherwise classified) Pricing File 4. For the first quarter of 2012, a payment rate $1,961.00 has been assigned for the 2 mg vial. Under CMS's Conditions for Coverage for hospitals and ASCs, $1,961 is the full payment for a single-use vial and providers must discard the vial after treating one patient.

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