Intravitreal Medications for Geographic Atrophy – Retinal Physician
Billing questions will arise with new drug treatment.
According to the American Academy of Ophthalmology EyeWiki, “Geographic atrophy is a chronic progressive degeneration of the macula, as part of late-stage age-related macular degeneration (AMD). The disease is characterized by localized sharply demarcated atrophy of outer retinal tissue, retinal pigment epithelium and choriocapillaris. It starts typically in the perifoveal region and expands to involve the fovea with time, leading to central scotomas and permanent loss of visual acuity. It is bilateral in most cases. Over 8 million people are affected worldwide with GA, approximately 20% of all individuals with AMD. The incidence of GA is expected to rise as the age-burden of developed countries is increasing.”1
This article addresses the following questions:
- How is geographic atrophy (GA) identified?
- How is GA treated?
- How are avacincaptad pegol and pegcetacoplan administered?
- Are there any HCPCS J-codes for intravitreal complement inhibitors to treat GA?
- What chart documentation is important for intravitreal injections?
- What are the reimbursement implications if the ophthalmologist injects a complement inhibitor and an anti-VEGF agent in the same eye on the same day?
- What is the CMS policy on billing for free samples of drugs?
This article was published in Retinal Physician, which is written by Corcoran’s Executive Vice-President, Suzanne Corcoran, COE. To view the entire article in Retinal Physician, click on the link below: