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Byooviz (ranibizumab-nuna)


Billing

Code: Q5124

Description: Inj. byooviz, 0.1 mg

Unit: 0.1 mg

Payment: $235.950

Pay quarter: Q1 2023


Medicare history

Dosage and Frequency

Neovascular (Wet) Age-Related Macular Degeneration (AMD)
Macular Edema Following Retinal Vein Occlusion(RVO)

• 0.5mg IVT every 1 month

Myopic Choroidal Neovascularization (mCNV)

• 0.5mg IVT every 1 month for up to 3 months

Calculate drug reimbursement


Total Reimbursement:

$1,250.53

(ASP: $1,179.75, Margin: $70.79)


Code:

Q5124

# Units to bill:

5

Prior Authorization

Prior auth criteria for Byooviz may include but is not limited to:





Insurance prior auth guidelines:


Billable NDCs

64406-0019-01

Byooviz (Biogen)

0.5 mg



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