Patients Win with Immediate Avastin Payment Reversal
Following an aggressive joint campaign by the American Academy of Ophthalmology, the American Society of Retina Specialists, the Macula Society and the Retina Society, CMS indicates it will no longer recognize code Q2024 for payment of office-based claims, and practitioners are directed to return to their previous reporting practice for small intraocular doses of Avastin. CMS had implemented Q2024 with a payment of $7 on Oct. 1, creating a significant gap in Avastin payment for ophthalmology.

In its reversal, CMS said, “Effective immediately, CMS no longer recognizes Healthcare Common Procedure Coding System (HCPCS) Code Q2024 Avastin for payment of non-outpatient hospital claims. Practitioners shall return to their previous reporting practice for small intraocular doses of Avastin furnished prior to Oct. 1. HCPCS Code Q2024 will be deleted as of Jan. 1, 2010, and, therefore, it will be removed from the Average Sales Price pricing file effective with the January 2010 Release.” For facility-based services, the Q2024 will be in effect until Dec. 31. After that date, hospitals should use C9257 for any ophthalmic use of Avastin.

Medicare claims processing contractors are to post information pertaining to the reversal on their Web sites within five days to inform providers of this policy change. In addition, CMS has instructed Medicare contractors to reprocess any claims from physicians for Avastin administered in their offices that were paid based on the Q2024 code, if requested by the physician. The Academy advises members to check their carrier Web sites for further details and instructions.

If you have questions, contact the Academy’s Governmental Affairs office at 202.737.6662.