CommercialPrior AuthMedium impact
08.00.74x, 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, 2025
We identified it
Jun 19, 2026
Summary
This policy updates medical necessity criteria for intravitreal injections of VEGF antagonists, VEGF biosimilars, and combination VEGF/Ang-2 inhibitors effective January 1, 2025. The billing team must review the revised criteria to ensure proper authorization and documentation requirements are met for these eye injections.
Action Required
By December 31, 2024: Billing team must obtain and review the full policy text at the provided URL to identify specific medical necessity criteria changes. Update prior authorization workflows and claim submission processes accordingly. Coordinate with ophthalmology providers to ensure they understand new documentation requirements. Beginning January 1, 2025, all claims for intravitreal VEGF antagonist injections must meet updated medical necessity criteria or face denial. Failure to implement changes before the effective date may result in claim rejections.