MedicaidBilling CodesHigh impact
Updated Billing Guidance Concerning Off-label Use of Avastin - Bevacizumab pdf
Connecticut Medicaid (HUSKY Health)·CT · Ophthalmology·Provider Bulletin
Effective date
May 1, 2019
We identified it
Jun 20, 2026
Summary
The Department of Social Services updated billing requirements for off-label Avastin injections used to treat age-related macular degeneration. Claims must now report quantities in milliliters (ML) with a maximum threshold of 0.05 ml, and reimbursement will be based on Wholesale Acquisition Cost (WAC) instead of the HCPCS fee schedule amount.
Action Required
Immediately: Billing team must update claim submission procedures for off-label Avastin (HCPCS J9035) with NDC 50242-0060-01 or NDC 50242-0061-01. Report quantities in milliliters (ML) only and ensure quantities do not exceed 0.05 ml threshold. Update billing system to use ML or UN units of measure only. Claims exceeding thresholds or using incorrect units will be denied.