CMS changes bevacizumab reimbursement

December 2, 2009

The Centers for Medicare and Medicaid Services has stopped recognizing code Q2024 to pay for the office-based ophthalmic use of bevacizumab (Avastin, Genentech).

Baltimore

-The Centers for Medicare and Medicaid Services (CMS) has stopped recognizing code Q2024 to pay for the office-based ophthalmic use of bevacizumab (Avastin, Genentech). The action follows a joint campaign by the American Academy of Ophthalmology (AAO), the American Society of Retina Specialists, the Macula Society, and the Retina Society, the AAO reported in its Nov. 19 Academy Express newsletter.

CMS passed a new rule in October mandating remuneration for office-based claims submitted for small intraocular doses of bevacizumab. The compensation amount was established using the average price of the drug plus 6%, the margin meant to cover a physician’s costs as a proficient provider, but it did not factor in compounding costs, which range from $15 to $45. Physicians wishing to be reimbursed retroactively for the Q2024 code must request it from their Medicare contractors.The Q2024 code will be effective until Dec. 31 for facility-based services. Afterward, hospitals should use C9257 for any ophthalmic use of bevacizumab, according to the AAO.