How do we bill for intravitreal injections of Avastin when performed in an ambulatory surgery center (ASC)?

Answer:
When performed in the ASC, the facility bills for the drug. The physician only bills the procedure. There is a site of service differential in the RVU, the facility having the lower value.

When billing for drug used in the office, accurately report units of drugs per the dosage specified in health care procedure code system (HCPCS) descriptor. Do not bill units based on the way the drug is packaged, stored or stocked.

Single dose syringes of Avastin are prepared with overfill to allow the needle to primed prior to the injection. See our article on Billing Silicon-free Avastin. The overfill is not considered waste.

Include the medication name and dosage in item 19 of the CMS 1500. The national drug code (NDC) should be reported on the CMS 1500, item 24a in 5-4-2 format. The NDC should be preceded with N4 qualifier. The unit of measure (UOM) should follow the NDC (e.g., ML0.05)

Additional education on coding for intravitreal injection can be found these Academy webpages:
Practice Management for Retina
Coding for Injectable Drugs
Retina Coding Complete Reference Guide

Send your retina coding questions to retinapm@aao.org.