Last Modified: 2/25/2024
Location: FL, PR, USVI
Business: Part A, Part B
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.
• 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
1. The patient received 300 mgs of J9035 (Injection, bevacizumab, 10 mgs). 1 unit = 10 mgs
• Report one line of J9035 with 30 units
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.
Multi-use vials are not subject to payment for discarded amounts of the drug.
Incorrect billing may result in the denial of the claim.
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.
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
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.