Advocacy & Practice Updates — Advocacy & Practice
WPS Will Reprocess Denied Claims for Dual Administrations of Anti-VEGF and Syfovre
Following advocacy from ASRS and AAO, Medicare Administrative Contractor (MACs) WPS confirmed this week that it will reprocess denied claims for injections of both an anti-VEGF and Syfovre administered within a short time frame to reimburse for the previously denied drug (usually the second one administered).
As we reported previously, CMS had implemented an edit to include complement inhibitors in the existing policy limiting anti-VEGF administration to once per 28-day interval. WPS, however, informed the societies that HCPCS code J2781 for Syfovre would no longer be included in the edit allowing for both types of drugs to be administered within FDA-approved dosing intervals. We are working to determine whether other complement inhibitors will be similarly removed from the edit and how other MACs will address this issue. We will keep you updated.
(Published 3.4.25)