CommercialCoverageMedium impact
08.00.74ab, Intravitreal Injection of Vascular Endothelial Growth Factor (VEGF) Antagonists, VEGF Biosimilars, and Combination VEGF/Angiopoietin-2 (Ang-2) Inhibitors
Independence Blue Cross·Ophthalmology·Pharmacy
Effective date
Jan 1, 2026
We identified it
Jun 19, 2026
Summary
Medical necessity criteria have been updated for intravitreal injection of VEGF antagonists, VEGF biosimilars, and combination VEGF/Angiopoietin-2 inhibitors used to treat eye conditions. This policy affects pharmacy billing for these specialized eye injection medications.
Action Required
Before January 1, 2026: Review and implement updated medical necessity criteria for VEGF antagonist intravitreal injections. Providers must ensure documentation meets new criteria requirements. Billing team should update prior authorization processes and verify coverage requirements with commercial payers for these ophthalmology medications.