Avastin – Intravitreal treatment for retinal vascular conditions: Report using HCPCS code C9257

Anthem will accept HCPCS code C9257 – when a physician is reporting Avastin – for Intravitreal Treatment for Retinal Vascular Conditions. Non-ophthalmologic indications should not be billed under C9257.

 

Professional billing of HCPCS code C9257 will ensure that the appropriate reimbursement is paid for this specific treatment. Physicians should no longer report codes J3490, J3590, J9035, or J9999 for Avastin used in intravitreal injections. Anthem has established a professional reimbursement allowance for code C9257 and will allow a maximum of five units per injection, per eye, per date of service. This reporting and reimbursement change impacts members enrolled in our commercial PAR/PPO and Anthem HealthKeepers plans only (excludes Medicaid).