Medicare AdvantagePrior AuthHigh 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
Changes to medical necessity criteria for intravitreal VEGF antagonist injections and related treatments for Medicare Advantage plans. This affects prior authorization requirements and coverage criteria for eye injections commonly used to treat macular degeneration and diabetic retinopathy.
Action Required
By August 3, 2026: Billing team must review and update prior authorization processes for intravitreal VEGF injections to align with new medical necessity criteria. Providers should review documentation requirements for eye injection procedures. Update billing system rules and encounter forms to reflect new coverage criteria for Medicare Advantage patients.