Lucentis (ranibizumab)
Billing
Code: J2778
Description: Ranibizumab injection
Unit: 0.1 mg
Payment: $236.583
Pay quarter: Q3 2023
Dosage and Frequency
Neovascular (Wet) Age-Related Macular Degeneration (AMD)
Macular Edema Following Retinal Vein Occlusion (RVO)
• 0.5mg IVT every 1 month
Macular Edema Following Retinal Vein Occlusion (RVO)
• 0.5mg IVT every 1 month
Diabetic Macular Edema (DME)
Diabetic Retinopathy (DR)
• 0.3mg IVT every 1 month
Diabetic Retinopathy (DR)
• 0.3mg IVT every 1 month
Myopic Choroidal Neovascularization (mCNV)
• 0.5mg IVT every 1 month for up to 3 months
• 0.5mg IVT every 1 month for up to 3 months
Calculate drug reimbursement
Total Reimbursement:
$1,253.89(ASP: $1,182.92, Margin: $70.97)
Code:
J2778# Units to bill:
5Prior Authorization
Prior auth criteria for Lucentis may include but is not limited to:
1. The patient must have a diagnosis of neovascular (wet) age-related macular degeneration (AMD) or macular edema following central retinal vein occlusion (CRVO).
2. The patient must have evidence of recent disease activity as determined by the presence of intraretinal or/and subretinal fluid.
3. The patient must have best corrected visual acuity of 20/40 or worse in the affected eye.
4. The patient must not have received prior treatment with either intravitreal anti-vascular endothelial growth factor therapy or photodynamic therapy within the previous 6 months.
5. The patient must not have any contraindication to treatment with Lucentis.
6. The patient must not have any concurrent conditions that may interfere with the safety or efficacy of Lucentis therapy.
Insurance prior auth guidelines:
Billable NDCs
50242-0080-02
Lucentis (GENENTECH, INC.)
0.5 mg
50242-0080-03
Lucentis (GENENTECH, INC.)
0.5 mg
50242-0082-02
Lucentis (GENENTECH, INC.)
0.30000000000000004 mg
50242-0082-03
Lucentis PFS (GENENTECH, INC.)
0.30000000000000004 MG
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