Reimbursement Rules for Intravitreal Injections – Retinal Physician

With audits likely on the way, it’s worthwhile to brush up.

Intravitreal injections (IVIs) are a mainstay of retina practice. Still, it is worthwhile reviewing the reimbursement issues of this common procedure. This is especially true now, with Medicare and other payers focusing audits on the procedure.

This article addresses the following questions:

  • What conditions are treated with intravitreal injection?
  • What documentation is needed to support these claims?
  • What considerations affect coding and reimbursement of IVIs?
  • Will insurance cover an off-label, investigational, or experimental use of medication delivered by IVI?
  • What CPT codes describe IVIs?
  • Both codes are designated “separate procedure.” What is the significance of this designation?
  • Is this procedure reimbursed during the postoperative period of another surgery?
  • Does place of service affect reimbursement for IVI?
  • How is the injected substance reimbursed?

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:;a-reimbursement-rules-for-intravitrea

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