Objective:

To provide updates on coding and billing practices for new geographic atrophy (GA) treatments in optometry and ophthalmology, emphasizing compliance and reimbursement.

Key Findings:

• Pegcetacoplan and avacincaptad pegol have specific HCPCS codes for billing.
• Accurate billing requires knowledge of drug dosage and administration volume.
• CMS modifiers enhance billing accuracy for single-dose containers.
• Documentation must include medication details and relevant ICD-10 codes.
• Funding shortages for patient assistance programs may lead to treatment access issues, impacting patient care.

Interpretation:

Healthcare providers must stay updated on coding and billing changes to ensure compliance, optimize reimbursement, and maintain patient access to GA treatments.

Limitations:

• Changes in coding and billing practices may occur frequently, impacting compliance.
• Patient assistance funding may be limited or unavailable, affecting treatment access.

Conclusion:

Understanding and implementing proper coding and billing practices is crucial for managing GA treatments and ensuring patient access to necessary care, especially in light of funding challenges.