SEP 19, 2018
Different Avastin HCPCS Codes
Question: We have a retinal surgeon joining our practice who will be injecting Avastin. The surgeon provided us with J3590 as the code to submit, but we’ve received denials from our MAC, Palmetto GBA. Is there another code we should be using?
Answer: Although Palmetto GBA does not have a LCD policy or article, they do list on their website that they expect Avastin to be submitted with J9035.
Each payer may use different codes, including secondary payers since there is no specific code for Avastin. It may be J3590, J9035 or J7999. You will need to do some research with your payers on their guidelines.
Learn more about injections in the Complete Guide to Retina Coding.