This update provides additional clarification on how Apple Health providers should bill for Avastin (bevacizumab).
Providers must bill for Avastin (bevacizumab) with the appropriate National Drug Code (NDC) for the product and one of the HCPCS and corresponding diagnosis codes from the Washington State Health Care Authority Prescription Drug Program Billing Guide.
In the table below, the accepted diagnoses codes are in the “Limitation” column. All other diagnoses are noncovered.
| HCPCS Code | Drug | Limitation |
| J9035 | bevacizumab (Avastin) | C00-D49 |
| Q5107 | bevacizumab-awwb (MVASI) | C00-D49 |
| Q5118 | bevacizumab-bvzr (ZIRABEV) | C00-D49 |
| Q5126 | bevacizumab-maly (ALYMSYS) | C00-D49 |
| Q5129 | bevacizumab-adcd (vegzelma) | C00-D49 |
| J7999 |
|
H35.32XX, E08.3XX, E08.32XX, E08.33XX, E08.34XX, E08.35XX, E09.32XX, E09.33XX, E09.34XX, E09.35XX, E10.32XX, E10.33XX, E10.34XX, E10.35XX, E11.32XX, E11.33XX, E11.34XX, E11.35XX |
Note: For wet age-related macular degeneration (AMD) or Retinopathy due to diabetes mellitus, claims will be reimbursed only when billed with an NDC for 4mL vial using an ophthalmology billing taxonomy.
If you have any questions, please refer to the Washington State Health Care Authority Prescription Drug Program Billing Guide or email CHPW’s Claims Investigation Unit (CIU), [email protected].
