Advocacy & Practice Updates — Advocacy & Practice
Novitas and First Coast Service Options Will Reprocess Denied Claims for Dual Administrations of Anti-VEGF and Syfovre
Two more Medicare Administrative Contractors, Novitas and First Coast, are removing policy edits after ASRS and AAO shared examples of denied claims for injections of both an anti-VEGF and Syfovre administered within a short time frame and they will now 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. The societies were informed 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. As we find out more information, we will keep you updated.
(Published 3.11.25)