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Asset Publisher
Ranibizumab: Lucentis®; Byooviz™; Cimerli™
Policy Number: PH-0078
Intravitreal
Last Review Date: 10/03/2023
Date of Origin: 01/01/2012
Dates Reviewed: 03/2012, 06/2012, 09/2012, 12/2012, 02/2013, 03/2013, 06/2013, 09/2013, 12/2013, 03/2014, 06/2014, 09/2014, 12/2014, 03/2015, 06/2015, 09/2015, 12/2015, 03/2016, 04/2016, 05/2016, 09/2016, 12/2016, 01/2017, 03/2017, 04/2017, 06/2017, 09/2017, 12/2017, 03/2018, 06/2018, 10/2018, 10/2019, 10/2020, 10/2021, 12/2021, 05/2022, 09/2022, 10/2023
FOR PEEHIP Members Only -Coverage excludes the provider-administered medication(s) outlined in this drug policy from being accessed through a specialty pharmacy. It must be obtained through buy and bill. |
- Length of Authorization
- Coverage for myopic choroidal neovascularization (mCNV) will be provided for 3 months and may be renewed.
- Coverage for all other indications will be provided annually and may be renewed.
- Dosing Limits
- Quantity Limit (max daily dose) [NDC unit]:
- 0.3 mg vial/prefilled syringe for injection: 1 vial/syringe per eye every 28 days
- 0.5 mg vial/prefilled syringe for injection: 1 vial/syringe per eye every 28 days
- Max Units (per dose and over time) [HCPCS Unit]:
Neovascular Age-related Macular Degeneration (AMD)/ Macular Edema following Retinal Vein Occlusion (RVO)/Myopic Choroidal Neovascularization (mCNV)
- 10 billable units every 28 days
Diabetic Macular Edema (DME)/Diabetic Retinopathy (DR)
- 6 billable units every 28 days
(Max units are based on administration to both eyes)
- Initial Approval Criteria 1-27
Coverage is provided in the following conditions:
For PEEHIP Members Only |
Bevacizumab is the preferred product for the following conditions: Neovascular (Wet) Age Related Macular Degeneration, Macular Edema following Retinal Vein Occlusion, Diabetic Macular Edema, and Diabetic Retinopathy.
Lucentis or Eylea are the preferred products after bevacizumab products
|
For Commercial Members Only |
Bevacizumab is the preferred product for the following conditions: Neovascular (Wet) Age Related Macular Degeneration, Macular Edema following Retinal Vein Occlusion, Diabetic Macular Edema, and Diabetic Retinopathy.
|
- Patient is at least 18 years of age; AND
Universal Criteria
- Patient is free of ocular and/or peri-ocular infections; AND
- Therapy will not be used with other ophthalmic vascular endothelial growth factor (VEGF) inhibitors (e.g., aflibercept, brolucizumab, bevacizumab, ranibizumab via ocular implant*, etc.); AND
- Patient’s best corrected visual acuity (BCVA) is measured at baseline and periodically during treatment; AND
- Patient has a definitive diagnosis of one of the following:
Neovascular (Wet) Age-Related Macular Degeneration (AMD) †
Diabetic Macular Edema (DME) †
Diabetic Retinopathy (DR) †
Macular Edema following Retinal Vein Occlusion (RVO) †
Myopic Choroidal Neovascularization (mCNV) †
*Note: Ranibizumab may be used as ‘supplemental-treatment’ in conjunction with Susvimo (ranibizumab via ocular implant) for Neovascular (Wet) Age-Related Macular Degeneration (nAMD), if clinically necessary
† FDA Approved Indication(s); ‡ Compendia Recommended Indication(s); Ф Orphan Drug
- Renewal Criteria 1-27
Coverage can be renewed based upon the following criteria:
- Patient continues to meet the universal and indication-specific relevant criteria as identified in section III; AND
- Absence of unacceptable toxicity from the drug. Examples of unacceptable toxicity include the following: endophthalmitis and retinal detachments, increase in intraocular pressure, arterial thromboembolic events, etc.; AND
- Patient has had a beneficial response to therapy (e.g., improvement in the baseline best corrected visual acuity (BCVA), etc.) and continued administration is necessary for the maintenance treatment of the condition; OR
- Myopic choroidal neovascularization ONLY: Continued administration is necessary due to disease activity [i.e., drop in vision, visual symptoms (e.g., metamorphopsia), or the presence of intra-/sub- retinal fluid or active leakage]
- Dosage/Administration 1-4
Indication |
Dose |
|
Diabetic macular edema (DME) and Diabetic retinopathy (DR) |
0.3 mg intravitreally per affected eye once a month (approximately 28 days) |
|
Neovascular (wet) age-related macular degeneration (AMD)* and Macular edema following retinal vein occlusion (RVO) |
0.5 mg intravitreally per affected eye once a month (approximately 28 days) |
|
Myopic choroidal neovascularization (mCNV) |
0.5 mg intravitreally per affected eye once a month (approximately 28 days) for up to 3 months. Patients may be retreated if needed. |
|
* Note: Patients with Neovascular (wet) AMD may alternatively be treated with 3 monthly doses followed by less frequent dosing (4-5 doses on average in the following 9 months) or one dose every 3 months after 4 monthly doses. Patients should be assessed regularly. |
- Billing Code/Availability Information
HCPCS Code(s):
- J2778 – Injection, ranibizumab, 0.1 mg; 1 billable unit = 0.1 mg (Lucentis Only)
- Q5124 – Injection, ranibizumab-nuna, biosimilar, (byooviz), 0.1 mg; 1 billable unit = 0.1 mg (Byooviz Only)
- Q5128 – Injection, ranibizumab-eqrn, biosimilar (cimerli), 0.1 mg; 1 billable unit = 0.1 mg (Cimerli Only)
NDC(s):
- Lucentis 0.3 mg/0.05 mL single-use vial/prefilled syringe for injection: 50242-0082-xx
- Lucentis 0.5 mg/0.05 mL single-use vial/prefilled syringe for injection: 50242-0080-xx
- Byooviz 0.5 mg/0.05 mL single-use vial for injection: 64406-0019-xx
- Cimerli 0.3 mg/0.05 mL single-use vial for injection: 70114-0440-xx
- Cimerli 0.5 mg/0.05 mL single-use vial for injection: 70114-0441-xx
- References
- Lucentis [package insert]. South San Francisco, CA; Genentech, Inc; August 2023. Accessed September 2023.
- Byooviz [package insert]. Cambridge, MA; Biogen, Inc; June 2023. Accessed September 2023.
- Cimerli [package insert]. Redwood City, CA; Coherus BioSciences, Inc; November 2022. Accessed September 2023.
- Susvimo [package insert]. South San Francisco, CA; Genentech, Inc; April 2022. Accessed September 2023.
- Massin P. Phase 2 RESOLVE trial: Twelve-month analysis of ranibizumab in diabetic macular edema. Abstract presented at the American Academy of Ophthalmology Annual Meeting. Atlanta, GA; 2008 Nov 9. Abstract PA016.
- Elman MJ, Aiello LP, Beck RW, et al. Randomized trial evaluating ranibizumab plus prompt or deferred laser or triamcinolone plus prompt laser for diabetic macular edema. Ophthalmology 2010. Epub ahead of print, doi:10.1016/j.ophtha.2010.02.031.
- Nguyen QD, Shah SM, Heier JS. Primary end point (six months) results of the ranibizumab for edema of the macula in diabetes (READ-2) study. Ophthalmology 2009;116:2175-81.
- Filho JA, Messias A, Almeida FP, et al. Panretinal photocoagulation (PRP) versus PRP plus intravitreal ranibizumab for high-risk proliferative diabetic retinopathy. Acta Ophthalmol 2011.
- Danyliv A, Glanville J, McCool R, et al. The Clinical Effectiveness of Ranibizumab Treat and Extend Regimen in nAMD: Systematic Review and Network Meta-Analysis. Adv Ther. 2017 Mar;34(3):611-619.
- Diabetic Retinopathy Clinical Research Network, Wells JA, Glassman AR, Ayala AR, Jampol LM, Aiello LP, Antoszyk AN, Arnold-Bush B, Baker CW, Bressler NM, Browning DJ, Elman MJ, Ferris FL, Friedman SM, Melia M, Pieramici DJ, Sun JK, Beck RW. Aflibercept, Bevacizumab, or Ranibizumab for Diabetic Macular Edema. N Engl J Med. 2015 Mar 26; 372(13): 1193–1203. DOI: 10.1056/NEJMoa1414264
- John A. Wells, Adam R. Glassman, Lee M. Jampol, et al, for the Diabetic Retinopathy Clinical Research Network. Association of Baseline Visual Acuity and Retinal Thickness with 1-year Efficacy of Aflibercept, Bevacizumab, and Ranibizumab for Diabetic Macular Edema. JAMA Ophthalmol. 2016 Feb;134(2):127-34. doi: 10.1001/jamaophthalmol.2015.4599
- Heier JS, Brown DM, Chong V, et al. Intravitreal aflibercept (VEGF trap-eye) in wet age-related macular degeneration. Ophthalmology. 2012 Dec;119(12):2537-48.
- Szabo SM, Hedegaard M, Chan K, et al. Ranibizumab vs. aflibercept for wet age-related macular degeneration: network meta-analysis to understand the value of reduced frequency dosing. Curr Med Res Opin. 2015 Nov;31(11):2031-42.
- Gillies MC, Nguyen V, Daien V, et al. Twelve-Month Outcomes of Ranibizumab vs. Aflibercept for Neovascular Age-Related Macular Degeneration: Data from an Observational Study. Ophthalmology. 2016 Dec;123(12):2545-2553.
- Barthelmes D, Campain A, Nguyen P, et al. Effects of switching from ranibizumab to aflibercept in eyes with exudative age-related macular degeneration. Br J Ophthalmol. 2016 Dec;100(12):1640-1645.
- Wong TY, Ohno-Matsui K, Leveziel N, et al. Myopic choroidal neovascularisation: current concepts and update on clinical management. Br J Ophthalmol. 2015 Mar;99(3):289-96.
- Solomon SD, Chew E, Duh EJ, et al. Diabetic Retinopathy: A Position Statement by the American Diabetes Association. Diabetes Care. 2017 Mar;40(3):412-418.
- American Academy of Ophthalmology-Preferred Practice Patterns (AAO-PPP) Retina/Vitreous Panel, Hoskins Center for Quality Eye Care. Diabetic Retinopathy PPP – Update 2017. Nov 2017.
- American Academy of Ophthalmology-Preferred Practice Patterns (AAO-PPP) Retina/Vitreous Panel, Hoskins Center for Quality Eye Care. Retinal Vein Occlusions PPP – Update 2017. Nov 2017.
- American Academy of Ophthalmology-Preferred Practice Patterns (AAO-PPP) Retina/Vitreous Panel, Hoskins Center for Quality Eye Care. Age-Related Macular Degeneration PPP – Update 2017. Nov 2017.
- Royal College of Ophthalmologists. Clinical Guidelines – Retinal Vein Occlusion (RVO) Guidelines – July 2015. Accessed at https://www.rcophth.ac.uk/standards-publications-research/clinical-guidelines.
- Wells JA, Glassman AR, Ayala AR, et al. Aflibercept, Bevacizumab, or Ranibizumab for Diabetic Macular Edema: Two-Year Results from a Comparative Effectiveness Randomized Clinical Trial. Ophthalmology 2016;123(6):1351-9. doi.org/10.1016/j.ophtha.2016.02.022
- American Academy of Ophthalmology-Preferred Practice Patterns (AAO-PPP) Retina/Vitreous Committee, Hoskins Center for Quality Eye Care. Diabetic Retinopathy PPP – Update 2019. Oct 2019. (Interim update March 2022).
- American Academy of Ophthalmology-Preferred Practice Patterns (AAO-PPP) Retina/Vitreous Committee, Hoskins Center for Quality Eye Care. Retinal Vein Occlusions PPP – Update 2019. Oct 2019.
- American Academy of Ophthalmology-Preferred Practice Patterns (AAO-PPP) Retina/Vitreous Committee, Hoskins Center for Quality Eye Care. Age-Related Macular Degeneration PPP – Update 2019. Oct 2019. (Interim update March 2022).
- American Academy of Ophthalmology-Preferred Practice Patterns (AAO-PPP) Retina/Vitreous Panel, Hoskins Center for Quality Eye Care. Retina Summary Benchmarks-2022. December 2022.
- Chandra S, McKibbin M, Mahmood S, et al. The Royal College of Ophthalmologists Commissioning guidelines on age macular degeneration: executive summary. Eye 36, 2078–2083 (2022). https://doi.org/10.1038/s41433-022-02095-2
- National Government Services, Inc. Local Coverage Article: Billing and Coding: Ranibizumab and biosimilars, Aflibercept, Brolucizumab-dbll and Faricimab-svoa (A52451). Centers for Medicare & Medicaid Services, Inc. Updated on 03/24/2023 with effective date 04/01/2023. Accessed September 2023.
Appendix 1 – Covered Diagnosis Codes
ICD-10 |
ICD-10 Description |
E08.311 |
Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy with macular edema |
E08.319 |
Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy without macular edema |
E08.3211 |
Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, right eye |
E08.3212 |
Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, left eye |
E08.3213 |
Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, bilateral |
E08.3219 |
Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye |
E08.3291 |
Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, right eye |
E08.3292 |
Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, left eye |
E08.3293 |
Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, bilateral |
E08.3299 |
Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye |
E08.3311 |
Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, right eye |
E08.3312 |
Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, left eye |
E08.3313 |
Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, bilateral |
E08.3319 |
Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye |
E08.3391 |
Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema, right eye |
E08.3392 |
Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema, left eye |
E08.3393 |
Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema, bilateral |
E08.3399 |
Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema, unspecified eye |
E08.3411 |
Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema, right eye |
E08.3412 |
Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema, left eye |
E08.3413 |
Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema, bilateral |
E08.3419 |
Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye |
E08.3491 |
Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema, right eye |
E08.3492 |
Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema, left eye |
E08.3493 |
Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema, bilateral |
E08.3499 |
Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema, unspecified eye |
E08.3511 |
Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, right eye |
E08.3512 |
Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, left eye |
E08.3513 |
Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, bilateral |
E08.3519 |
Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, unspecified eye |
E08.3521 |
Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye |
E08.3522 |
Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye |
E08.3523 |
Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral |
E08.3529 |
Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula, unspecified eye |
E08.3531 |
Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye |
E08.3532 |
Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye |
E08.3533 |
Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral |
E08.3539 |
Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye |
E08.3541 |
Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye |
E08.3542 |
Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye |
E08.3543 |
Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral |
E08.3549 |
Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye |
E08.3551 |
Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, right eye |
E08.3552 |
Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, left eye |
E08.3553 |
Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, bilateral |
E08.3559 |
Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, unspecified eye |
E08.3591 |
Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema, right eye |
E08.3592 |
Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema, left eye |
E08.3593 |
Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema, bilateral |
E08.3599 |
Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema, unspecified eye |
E08.37X1 |
Diabetes mellitus due to underlying condition with diabetic macular edema, resolved following treatment, right eye |
E08.37X2 |
Diabetes mellitus due to underlying condition with diabetic macular edema, resolved following treatment, left eye |
E08.37X3 |
Diabetes mellitus due to underlying condition with diabetic macular edema, resolved following treatment, bilateral |
E08.37X9 |
Diabetes mellitus due to underlying condition with diabetic macular edema, resolved following treatment, unspecified eye |
E09.311 |
Drug or chemical induced diabetes mellitus with unspecified diabetic retinopathy with macular edema |
E09.319 |
Drug or chemical induced diabetes mellitus with unspecified diabetic retinopathy without macular edema |
E09.3211 |
Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye |
E09.3212 |
Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye |
E09.3213 |
Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral |
E09.3219 |
Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye |
E09.3291 |
Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, right eye |
E09.3292 |
Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eye |
E09.3293 |
Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateral |
E09.3299 |
Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye |
E09.3311 |
Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye |
E09.3312 |
Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye |
E09.3313 |
Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral |
E09.3319 |
Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye |
E09.3391 |
Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, right eye |
E09.3392 |
Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, left eye |
E09.3393 |
Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, bilateral |
E09.3399 |
Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, unspecified eye |
E09.3411 |
Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye |
E09.3412 |
Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye |
E09.3413 |
Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateral |
E09.3419 |
Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye |
E09.3491 |
Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, right eye |
E09.3492 |
Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, left eye |
E09.3493 |
Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, bilateral |
E09.3499 |
Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, unspecified eye |
E09.3511 |
Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye |
E09.3512 |
Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eye |
E09.3513 |
Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral |
E09.3519 |
Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with macular edema, unspecified eye |
E09.3521 |
Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye |
E09.3522 |
Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye |
E09.3523 |
Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral |
E09.3529 |
Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, unspecified eye |
E09.3531 |
Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye |
E09.3532 |
Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye |
E09.3533 |
Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral |
E09.3539 |
Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye |
E09.3541 |
Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye |
E09.3542 |
Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye |
E09.3543 |
Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral |
E09.3549 |
Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye |
E09.3551 |
Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy, right eye |
E09.3552 |
Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy, left eye |
E09.3553 |
Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy, bilateral |
E09.3559 |
Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy, unspecified eye |
E09.3591 |
Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy without macular edema, right eye |
E09.3592 |
Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eye |
E09.3593 |
Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy without macular edema, bilateral |
E09.3599 |
Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eye |
E09.37X1 |
Drug or chemical induced diabetes mellitus with diabetic macular edema, resolved following treatment, right eye |
E09.37X2 |
Drug or chemical induced diabetes mellitus with diabetic macular edema, resolved following treatment, left eye |
E09.37X3 |
Drug or chemical induced diabetes mellitus with diabetic macular edema, resolved following treatment, bilateral |
E09.37X9 |
Drug or chemical induced diabetes mellitus with diabetic macular edema, resolved following treatment, unspecified eye |
E10.311 |
Type 1 diabetes mellitus with unspecified diabetic retinopathy with macular edema |
E10.319 |
Type 1 diabetes mellitus with unspecified diabetic retinopathy without macular edema |
E10.3211 |
Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye |
E10.3212 |
Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye |
E10.3213 |
Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral |
E10.3219 |
Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye |
E10.3291 |
Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, right eye |
E10.3292 |
Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eye |
E10.3293 |
Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateral |
E10.3299 |
Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye |
E10.3311 |
Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye |
E10.3312 |
Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye |
E10.3313 |
Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral |
E10.3319 |
Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye |
E10.3391 |
Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, right eye |
E10.3392 |
Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, left eye |
E10.3393 |
Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, bilateral |
E10.3399 |
Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, unspecified eye |
E10.3411 |
Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye |
E10.3412 |
Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye |
E10.3413 |
Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateral |
E10.3419 |
Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye |
E10.3491 |
Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, right eye |
E10.3492 |
Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, left eye |
E10.3493 |
Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, bilateral |
E10.3499 |
Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, unspecified eye |
E10.3511 |
Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye |
E10.3512 |
Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eye |
E10.3513 |
Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral |
E10.3519 |
Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, unspecified eye |
E10.3521 |
Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye |
E10.3522 |
Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye |
E10.3523 |
Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral |
E10.3529 |
Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, unspecified eye |
E10.3531 |
Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye |
E10.3532 |
Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye |
E10.3533 |
Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral |
E10.3539 |
Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye |
E10.3541 |
Type 1 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye |
E10.3542 |
Type 1 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye |
E10.3543 |
Type 1 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral |
E10.3549 |
Type 1 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye |
E10.3551 |
Type 1 diabetes mellitus with stable proliferative diabetic retinopathy, right eye |
E10.3552 |
Type 1 diabetes mellitus with stable proliferative diabetic retinopathy, left eye |
E10.3553 |
Type 1 diabetes mellitus with stable proliferative diabetic retinopathy, bilateral |
E10.3559 |
Type 1 diabetes mellitus with stable proliferative diabetic retinopathy, unspecified eye |
E10.3591 |
Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema, right eye |
E10.3592 |
Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eye |
E10.3593 |
Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema, bilateral |
E10.3599 |
Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eye |
E10.37X1 |
Type 1 diabetes mellitus with diabetic macular edema, resolved following treatment, right eye |
E10.37X2 |
Type 1 diabetes mellitus with diabetic macular edema, resolved following treatment, left eye |
E10.37X3 |
Type 1 diabetes mellitus with diabetic macular edema, resolved following treatment, bilateral |
E10.37X9 |
Type 1 diabetes mellitus with diabetic macular edema, resolved following treatment, unspecified eye |
E11.311 |
Type 2 diabetes mellitus with unspecified diabetic retinopathy with macular edema |
E11.319 |
Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema |
E11.3211 |
Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye |
E11.3212 |
Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye |
E11.3213 |
Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral |
E11.3219 |
Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye |
E11.3291 |
Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, right eye |
E11.3292 |
Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eye |
E11.3293 |
Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateral |
E11.3299 |
Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye |
E11.3311 |
Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye |
E11.3312 |
Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye |
E11.3313 |
Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral |
E11.3319 |
Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye |
E11.3391 |
Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, right eye |
E11.3392 |
Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, left eye |
E11.3393 |
Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, bilateral |
E11.3399 |
Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, unspecified eye |
E11.3411 |
Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye |
E11.3412 |
Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye |
E11.3413 |
Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateral |
E11.3419 |
Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye |
E11.3491 |
Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, right eye |
E11.3492 |
Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, left eye |
E11.3493 |
Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, bilateral |
E11.3499 |
Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, unspecified eye |
E11.3511 |
Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye |
E11.3512 |
Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eye |
E11.3513 |
Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral |
E11.3519 |
Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, unspecified eye |
E11.3521 |
Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye |
E11.3522 |
Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye |
E11.3523 |
Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral |
E11.3529 |
Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, unspecified eye |
E11.3531 |
Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye |
E11.3532 |
Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye |
E11.3533 |
Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral |
E11.3539 |
Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye |
E11.3541 |
Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye |
E11.3542 |
Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye |
E11.3543 |
Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral |
E11.3549 |
Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye |
E11.3551 |
Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, right eye |
E11.3552 |
Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, left eye |
E11.3553 |
Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, bilateral |
E11.3559 |
Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, unspecified eye |
E11.3591 |
Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, right eye |
E11.3592 |
Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eye |
E11.3593 |
Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, bilateral |
E11.3599 |
Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eye |
E11.37X1 |
Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, right eye |
E11.37X2 |
Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, left eye |
E11.37X3 |
Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, bilateral |
E11.37X9 |
Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, unspecified eye |
E13.311 |
Other specified diabetes mellitus with unspecified diabetic retinopathy with macular edema |
E13.319 |
Other specified diabetes mellitus with unspecified diabetic retinopathy without macular edema |
E13.3211 |
Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye |
E13.3212 |
Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye |
E13.3213 |
Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral |
E13.3219 |
Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye |
E13.3291 |
Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, right eye |
E13.3292 |
Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eye |
E13.3293 |
Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateral |
E13.3299 |
Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye |
E13.3311 |
Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye |
E13.3312 |
Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye |
E13.3313 |
Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral |
E13.3319 |
Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye |
E13.3391 |
Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, right eye |
E13.3392 |
Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, left eye |
E13.3393 |
Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, bilateral |
E13.3399 |
Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, unspecified eye |
E13.3411 |
Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye |
E13.3412 |
Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye |
E13.3413 |
Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateral |
E13.3419 |
Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye |
E13.3491 |
Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, right eye |
E13.3492 |
Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, left eye |
E13.3493 |
Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, bilateral |
E13.3499 |
Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, unspecified eye |
E13.3511 |
Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye |
E13.3512 |
Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eye |
E13.3513 |
Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral |
E13.3519 |
Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, unspecified eye |
E13.3521 |
Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye |
E13.3522 |
Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye |
E13.3523 |
Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral |
E13.3529 |
Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, unspecified eye |
E13.3531 |
Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye |
E13.3532 |
Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye |
E13.3533 |
Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral |
E13.3539 |
Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye |
E13.3541 |
Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye |
E13.3542 |
Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye |
E13.3543 |
Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral |
E13.3549 |
Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye |
E13.3551 |
Other specified diabetes mellitus with stable proliferative diabetic retinopathy, right eye |
E13.3552 |
Other specified diabetes mellitus with stable proliferative diabetic retinopathy, left eye |
E13.3553 |
Other specified diabetes mellitus with stable proliferative diabetic retinopathy, bilateral |
E13.3559 |
Other specified diabetes mellitus with stable proliferative diabetic retinopathy, unspecified eye |
E13.3591 |
Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, right eye |
E13.3592 |
Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eye |
E13.3593 |
Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, bilateral |
E13.3599 |
Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eye |
E13.37X1 |
Other specified diabetes mellitus with diabetic macular edema, resolved following treatment, right eye |
E13.37X2 |
Other specified diabetes mellitus with diabetic macular edema, resolved following treatment, left eye |
E13.37X3 |
Other specified diabetes mellitus with diabetic macular edema, resolved following treatment, bilateral |
E13.37X9 |
Other specified diabetes mellitus with diabetic macular edema, resolved following treatment, unspecified eye |
H34.8110 |
Central retinal vein occlusion, right eye, with macular edema |
H34.8120 |
Central retinal vein occlusion, left eye, with macular edema |
H34.8130 |
Central retinal vein occlusion, bilateral, with macular edema |
H34.8190 |
Central retinal vein occlusion, unspecified eye, with macular edema |
H34.8310 |
Tributary (branch) retinal vein occlusion, right eye, with macular edema |
H34.8320 |
Tributary (branch) retinal vein occlusion, left eye, with macular edema |
H34.8330 |
Tributary (branch) retinal vein occlusion, bilateral, with macular edema |
H34.8390 |
Tributary (branch) retinal vein occlusion, unspecified eye, with macular edema |
H35.3210 |
Exudative age-related macular degeneration, right eye, stage unspecified |
H35.3211 |
Exudative age-related macular degeneration, right eye, with active choroidal neovascularization |
H35.3212 |
Exudative age-related macular degeneration, right eye, with inactive choroidal neovascularization |
H35.3213 |
Exudative age-related macular degeneration, right eye, with inactive scar |
H35.3220 |
Exudative age-related macular degeneration, left eye, stage unspecified |
H35.3221 |
Exudative age-related macular degeneration, left eye, with active choroidal neovascularization |
H35.3222 |
Exudative age-related macular degeneration, left eye, with inactive choroidal neovascularization |
H35.3223 |
Exudative age-related macular degeneration, left eye, with inactive scar |
H35.3230 |
Exudative age-related macular degeneration, bilateral, stage unspecified |
H35.3231 |
Exudative age-related macular degeneration, bilateral, with active choroidal neovascularization |
H35.3232 |
Exudative age-related macular degeneration, bilateral, with inactive choroidal neovascularization |
H35.3233 |
Exudative age-related macular degeneration, bilateral, with inactive scar |
H35.3290 |
Exudative age-related macular degeneration, unspecified eye, stage unspecified |
H35.3291 |
Exudative age-related macular degeneration, unspecified eye, with active choroidal neovascularization |
H35.3292 |
Exudative age-related macular degeneration, unspecified eye, with inactive choroidal neovascularization |
H35.3293 |
Exudative age-related macular degeneration, unspecified eye, with inactive scar |
H44.2A1 |
Degenerative myopia with choroidal neovascularization, right eye |
H44.2A2 |
Degenerative myopia with choroidal neovascularization, left eye |
H44.2A3 |
Degenerative myopia with choroidal neovascularization, bilateral eye |
H44.2A9 |
Degenerative myopia with choroidal neovascularization, unspecified eye |
Appendix 2 – Centers for Medicare and Medicaid Services (CMS)
Medicare coverage for outpatient (Part B) drugs is outlined in the Medicare Benefit Policy Manual (Pub. 100-2), Chapter 15, §50 Drugs and Biologicals. In addition, National Coverage Determination (NCD), Local Coverage Determinations (LCDs), and Local Coverage Articles (LCAs) may exist and compliance with these policies is required where applicable. They can be found at: https://www.cms.gov/medicare-coverage-database/search.aspx. Additional indications may be covered at the discretion of the health plan.
Medicare Part B Covered Diagnosis Codes (applicable to existing NCD/LCD/LCA):
Jurisdiction(s): 6, K |
NCD/LCD Document (s): A52451 |
Medicare Part B Administrative Contractor (MAC) Jurisdictions |
||
Jurisdiction |
Applicable State/US Territory |
Contractor |
E (1) |
CA, HI, NV, AS, GU, CNMI |
Noridian Healthcare Solutions, LLC |
F (2 & 3) |
AK, WA, OR, ID, ND, SD, MT, WY, UT, AZ |
Noridian Healthcare Solutions, LLC |
5 |
KS, NE, IA, MO |
Wisconsin Physicians Service Insurance Corp (WPS) |
6 |
MN, WI, IL |
National Government Services, Inc. (NGS) |
H (4 & 7) |
LA, AR, MS, TX, OK, CO, NM |
Novitas Solutions, Inc. |
8 |
MI, IN |
Wisconsin Physicians Service Insurance Corp (WPS) |
N (9) |
FL, PR, VI |
First Coast Service Options, Inc. |
J (10) |
TN, GA, AL |
Palmetto GBA, LLC |
M (11) |
NC, SC, WV, VA (excluding below) |
Palmetto GBA, LLC |
L (12) |
DE, MD, PA, NJ, DC (includes Arlington & Fairfax counties and the city of Alexandria in VA) |
Novitas Solutions, Inc. |
K (13 & 14) |
NY, CT, MA, RI, VT, ME, NH |
National Government Services, Inc. (NGS) |
15 |
KY, OH |
CGS Administrators, LLC |