Advocacy & Practice Updates — Advocacy & Practice

Aetna Will No Longer Require Precertification for Avastin, Use HCPCS Code C9257

The American Society of Retina Specialists contacted Aetna to oppose its new policy requiring precertification for Vascular Endothelial Growth Factor Inhibitors for Ocular Indications that included all anti-VEGFs. Aetna reviewed its policy and effective August 1, 2020, HCPCS Code C9257, Injection, bevacizumab, 0.25mg [Avastin] [intraocular dose], will not require precertification and can be billed from an office setting. This code will pay when combined with any of the covered diagnoses codes listed in the Clinical Policy Bulletin. If you used J9035 previously, please make note of this change.

In addition, Aetna stated that it would continue to review its step edits for branded anti-VEGF drugs, however, it did see cost savings in continuing the policy. ASRS will keep you posted on any new developments.

(Published 8.5.20)