MedicaidBilling CodesHigh impact
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
Effective May 1, 2019, ophthalmologists billing for off-label Avastin injections for age-related macular degeneration must report quantities in milliliters on claims and cannot exceed 0.05 ML threshold. Claims with incorrect units or excess quantities will be denied with specific EOB codes.
Action Required
Immediately: Ophthalmology billing team must update billing system to require milliliter (ML) reporting for Avastin (J9035) with NDCs 50242-0060-01 and 50242-0061-01. Enforce 0.05 ML maximum quantity limit. Train staff that quantities exceeding this threshold or using incorrect units of measure will result in claim denials with EOB codes 661 and 660.