5 Key Takeaways

• 1

  Geographic atrophy (GA) is a severe form of age-related macular degeneration (AMD) that causes progressive vision loss.

• 2

  New GA drugs require updates in coding and billing practices, with pegcetacoplan transitioning to HCPCS code J2781 on October 1, 2023.

• 3

  Billing units for GA drugs are based on dosage; pegcetacoplan is 15 units per 15 mg, while avacincaptad pegol is 20 units per 2 mg.

• 4

  The JW modifier is required for discarded drug amounts, while the JZ modifier is for when no drug is wasted, effective July 1, 2023.

• 5

  Good Days, a nonprofit aiding treatment costs, has exhausted funding for 2025, impacting patients' access to GA treatments and increasing provider burdens.