Eylea (Aflibercept) gets new HCPCS supply code

In a recent public notice, the Centers for Medicare and Medicaid (CMS) noted that a new HCPCS code, Q2046, will be in effect. In Transmittal 2450 to MACs and MM7854 for providers and other suppliers, Q2046 is described as “Injection, Aflibercept, 1 mg”.

  • The new HCPCS code is effective n July 1, 2012. Separate payment is allowed but some payers may request an Invoice.
  • Q2046 is specifically described as “1 mg”,the usual aflibercept (Eylea) dose per eye is 2 mg. Use “2units” on your claim after July 1, 2012.
  • The old C9291 code and associated units remain in effect for dates of services through June 30, 2012 – after which it will be deleted from HOPD and ASC payment systems.
  • For physican claims some MACs may prefer that another code for the supply of Eylea to be used instead of Q2046, be sure to check before filing claims.

Intravitreal injection use is under scrutiny by the OIG and other watchdog groups for 2012. Be sure you are in compliance. If you have questions, Corcoran Consulting Group can help. For more information, contact us at 800-399-6565, or request our separate FAQs on Eylea and Intravitreal Injections.

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