Medicare AdvantagePrior AuthMedium impact
MA08.073v, 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
Aug 3, 2026
We identified it
Jun 19, 2026
Summary
MA08.073v updates medical necessity criteria for intravitreal injections of VEGF antagonists, VEGF biosimilars, and combination VEGF/Ang-2 inhibitors for Medicare Advantage plans. The policy, effective August 3, 2026, modifies coverage rules and prior authorization requirements for these retinal treatments. Billing teams must review updated medical necessity documentation requirements before the effective date.
Action Required
By August 3, 2026: Billing team and providers must review MA08.073v policy updates and implement new medical necessity criteria for intravitreal VEGF antagonist claims. Update prior authorization submission templates in billing system to reflect revised criteria. Clinical staff must ensure patient charts include updated documentation supporting medical necessity per new guidelines. Obtain prior authorization from Medicare Advantage plans before service delivery. Claims submitted without updated documentation or prior authorization per new criteria will be denied. Access full policy at https://medpolicy.ibx.com/ibc/ma/Pages/Site-Activity-View.aspx?FilterField1=MPSiteActivityLogMonth&FilterValue1=05&FilterField2=MPSiteActivityLogYear&FilterValue2=2026#medicare-advantage-ma08-073v-intravitreal-injection-of-vascu