MedicaidBilling CodesHigh impact
Changes to fee-for-service Avastin (bevacizumab) billing for eye clinics, effective June 23, 2020
Oregon Health Plan·OR · Ophthalmology, Oncology·Provider
Effective date
Jun 23, 2020
We identified it
Jun 20, 2026
Summary
Effective June 23, 2020, Oregon Health Authority (OHA) will deny eye clinic claims for Avastin (bevacizumab) with incorrect NDC Unit of Measure (UOM) and Units. The correct billing for routine 1.25 mg doses is 0.05 ML using HCPCS code J7999, with a fee-for-service reimbursement of $30.00. Doses greater than 10 mg/0.4 ML for cancer treatment must use HCPCS code J9035. This applies to fee-for-service Medicaid members not enrolled in coordinated care organizations (CCOs).
Action Required
By June 23, 2020: Billing team must update claims submission protocols for Avastin (bevacizumab) in the eye clinic. (1) Ensure all routine Avastin doses (1.25 mg) are billed with NDC UOM and Units of 0.05 ML using HCPCS code J7999 only. (2) For doses greater than 10 mg/0.4 ML used for cancer treatment, use HCPCS code J9035. (3) Update billing system edits to validate correct UOM/Units before claim submission to Oregon Health Authority. (4) Educate providers and billing staff on the correct coding and unit measurements. (5) For questions about fee-for-service reimbursement or billing, contact DMAP.RXQUESTIONS@dhsoha.state.or.us. Failure to use correct NDC UOM and Units will result in claim denials by OHA.