Appropriate drug billing for Avastin (bevacizumab) J9035

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Home ► Billing news ► Appropriate drug billing for Avastin (bevacizumab) J9035

Last Modified: 2/25/2024 Location: FL, PR, USVI Business: Part A, Part B

Appropriate drug billing for Avastin (bevacizumab) - J9035

First Coast is providing the following information to remind providers how to properly compute the units of J9035 for Avastin (bevacizumab) to ensure the drug is reported accurately.

When billing for Avastin (bevacizumab), please remember to verify the milligrams given to the patient and then convert to the proper units for billing as specified in the HCPCS code descriptor. To accurately bill for bevacizumab, it is important to instruct your billing staff to verify the milligrams given, convert to the proper units for billing, and ensure the quantity administered is consistent with the units billed. Ensure you are differentiating between unit billing versus milligram billing.

Key points to remember

• J9035 is defined in the HCPCS manual as: Injection, bevacizumab, 10 mg

• One unit represents 10 mg of (J9035) or bevacizumab ordered/administered to patient

• Bevacizumab should be billed based on units, not total number of milligrams

Example

1. The patient received 300 mgs of J9035 (Injection, bevacizumab, 10 mgs). 1 unit = 10 mgs

• Report one line of J9035 with 30 units

Supplemental information

Before submitting the claim:

• Review the long descriptors for the HCPCS code you are billing. The short descriptors are limited to 28 characters, and they do not always capture the complete description of the drug.

• If the dosage given is not a multiple of the number provided in the HCPCS code description, round up to the nearest whole number in order to express the number as a multiple.

• If the remainder of a single-use vial must be discarded, clearly document in the patient’s medical record the actual dose administered in addition to the exact amount wasted and the total amount the vial is labeled to contain. Discarded drugs must be reported with the JW modifier on a separate claim line.

Discarded drugs

When billing for a single-use vial and part of the drug is being discarded, bill the discarded amount with the Avoid claim denials: Bill drug wastage correctly using the JW modifier on a separate line.

Multi-use vials are not subject to payment for discarded amounts of the drug.

Incorrect billing may result in the denial of the claim.

Off-label usage for ophthalmological diseases

Community Standards of Practice for off-label uses of Avastin include retinal diseases. For example, Avastin may be used for wet age-related macular degeneration (AMD), central-involved diabetic macular edema (CIDME), and proliferative diabetic retinopathy.

Billing and coding

In the office setting:

• Report HCPCS code J7999 (Compounded drug, no otherwise classified)

• Each 1.25 mg dose administered is considered one unit

• Total dosage administered should be noted in the "Remarks" section of the claim

In the hospital outpatient settings and ambulatory surgical centers (ASCs):

• Report HCPCS code C9257 (Injection, bevacizumab, 0.25 mg)

• Report appropriate number of units

Sources: National coverage determination (NCD) for bevacizumab: NCD 110.17 external link

Medicare Benefit Policy Manual, Chapter 15, Section 50 external pdf file

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