Reimbursement
This coding information may assist you as you complete payer forms. Correct coding is the responsibility of the provider submitting the claim for the item or service. Please check with the payer to verify codes and special billing requirements. Genentech does not make any representation or guarantee concerning reimbursement or coverage for any service or item.
ICD-10-CM Tool
For assistance obtaining ICD-10-CM codes, select an indication to start:
ICD-10-CM:
| E08.311 | Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy with 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 |
| E08.3311 | 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 |
| E08.3411 | 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 |
| E08.3511 | 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 |
| E08.37X1 | Diabetes mellitus due to underlying condition with macular edema resolved following treatment, right eye |
| E08.37X2 | Diabetes mellitus due to underlying condition with macular edema resolved following treatment, left eye |
| E08.37X3 | Diabetes mellitus due to underlying condition with macular edema resolved following treatment, bilateral |
| E08.37X9 | Diabetes mellitus due to underlying condition with macular edema resolved following treatment, unspecified eye |
| E10.311 | Type 1 diabetes with unspecified diabetic retinopathy with 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 |
| E10.3311 | 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 |
| E10.3411 | 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 |
| E10.3511 | 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 |
| E10.37X1 | Type 1 Diabetes mellitus with macular edema resolved following treatment, right eye |
| E10.37X2 | Type 1 Diabetes mellitus with macular edema resolved following treatment, left eye |
| E10.37X3 | Type 1 Diabetes mellitus with macular edema resolved following treatment, bilateral |
| E10.37X9 | Type 1 Diabetes mellitus with macular edema resolved following treatment, unspecified eye |
| E11.311 | Type 2 diabetes with unspecified diabetic retinopathy with 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 |
| E11.3311 | 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 |
| E11.3411 | 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 |
| E11.3511 | 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 |
| E11.37X1 | Type 2 Diabetes mellitus with macular edema resolved following treatment, right eye |
| E11.37X2 | Type 2 Diabetes mellitus with macular edema resolved following treatment, left eye |
| E11.37X3 | Type 2 Diabetes mellitus with macular edema resolved following treatment, bilateral |
| E11.37X9 | Type 2 Diabetes mellitus with macular edema resolved following treatment, unspecified eye |
| E13.311 | Other specified diabetes with unspecified diabetic retinopathy with 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 |
| E13.3311 | 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 |
| E13.3411 | 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 |
| E13.3511 | 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 |
| E13.37X1 | Other specified Diabetes mellitus with macular edema resolved following treatment, right eye |
| E13.37X2 | Other specified Diabetes mellitus with macular edema resolved following treatment, left eye |
| E13.37X3 | Other Specified Diabetes mellitus with macular edema resolved following treatment, bilateral |
| E13.37X9 | Other Specified Diabetes mellitus with macular edema resolved following treatment, unspecified eye |
| 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 |
| H35.051 | Retinal neovascularization, unspecified, right eye |
| H35.052 | Retinal neovascularization, unspecified, left eye |
| H35.053 | Retinal neovascularization, unspecified, bilateral |
| H35.059 | Retinal neovascularization, unspecified, unspecified eye |
| H44.20 | Degenerative myopia, unspecified eye |
| H44.21 | Degenerative myopia, right eye |
| H44.22 | Degenerative myopia, left eye |
| H44.23 | Degenerative myopia, bilateral |
| E08.311 | Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy with 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 |
| E08.3311 | 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 |
| E08.3411 | 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 |
| E08.3511 | 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 |
| E08.37X1 | Diabetes mellitus due to underlying condition with macular edema resolved following treatment, right eye |
| E08.37X2 | Diabetes mellitus due to underlying condition with macular edema resolved following treatment, left eye |
| E08.37X3 | Diabetes mellitus due to underlying condition with macular edema resolved following treatment, bilateral |
| E08.37X9 | Diabetes mellitus due to underlying condition with macular edema resolved following treatment, unspecified eye |
| E10.311 | Type 1 diabetes with unspecified diabetic retinopathy with 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 |
| E10.3311 | 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 |
| E10.3411 | 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 |
| E10.3511 | 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 |
| E10.37X1 | Type 1 Diabetes mellitus with macular edema resolved following treatment, right eye |
| E10.37X2 | Type 1 Diabetes mellitus with macular edema resolved following treatment, left eye |
| E10.37X3 | Type 1 Diabetes mellitus with macular edema resolved following treatment, bilateral |
| E10.37X9 | Type 1 Diabetes mellitus with macular edema resolved following treatment, unspecified eye |
| E11.311 | Type 2 diabetes with unspecified diabetic retinopathy with 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 |
| E11.3311 | 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 |
| E11.3411 | 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 |
| E11.3511 | 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 |
| E11.37X1 | Type 2 Diabetes mellitus with macular edema resolved following treatment, right eye |
| E11.37X2 | Type 2 Diabetes mellitus with macular edema resolved following treatment, left eye |
| E11.37X3 | Type 2 Diabetes mellitus with macular edema resolved following treatment, bilateral |
| E11.37X9 | Type 2 Diabetes mellitus with macular edema resolved following treatment, unspecified eye |
| E13.311 | Other specified diabetes with unspecified diabetic retinopathy with 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 |
| E13.3311 | 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 |
| E13.3411 | 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 |
| E13.3511 | 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 |
| E13.37X1 | Other specified Diabetes mellitus with macular edema resolved following treatment, right eye |
| E13.37X2 | Other specified Diabetes mellitus with macular edema resolved following treatment, left eye |
| E13.37X3 | Other Specified Diabetes mellitus with macular edema resolved following treatment, bilateral |
| E13.37X9 | Other Specified Diabetes mellitus with macular edema resolved following treatment, unspecified eye |
| H34.8110 | Central retinal vein occlusion, right eye, with macular edema |
| H34.8111 | Central retinal vein occlusion, right eye, with retinal revascularization |
| H34.8112 | Central retinal vein occlusion, right eye, stable |
| H34.8120 | Central retinal vein occlusion, left eye, with macular edema |
| H34.8121 | Central retinal vein occlusion, left eye, with retinal revascularization |
| H34.8122 | Central retinal vein occlusion, left eye, stable |
| H34.8130 | Central retinal vein occlusion, bilateral, with macular edema |
| H34.8131 | Central retinal vein occlusion, bilateral, with retinal revascularization |
| H34.8132 | Central retinal vein occlusion, bilateral, stable |
| H34.8190 | Central retinal vein occlusion, unspecified eye, with macular edema |
| H34.8191 | Central retinal vein occlusion, unspecified eye, with retinal revascularization |
| H34.8192 | Central retinal vein occlusion, unspecified eye, stable |
| H34.8310 | Tributary (branch) retinal vein occlusion, right eye, with macular edema |
| H34.8311 | Tributary (branch) retinal vein occlusion, right eye, with retinal revascularization |
| H34.8312 | Tributary (branch) retinal vein occlusion, right eye, stable |
| H34.8320 | Tributary (branch) retinal vein occlusion, left eye, with macular edema |
| H34.8321 | Tributary (branch) retinal vein occlusion, left eye, with retinal revascularization |
| H34.8322 | Tributary (branch) retinal vein occlusion, left eye, stable |
| H34.8330 | Tributary (branch) retinal vein occlusion, bilateral, with macular edema |
| H34.8331 | Tributary (branch) retinal vein occlusion, bilateral, with retinal revascularization |
| H34.8332 | Tributary (branch) retinal vein occlusion, bilateral, stable |
| H34.8390 | Tributary (branch) retinal vein occlusion, unspecified eye, with macular edema |
| H34.8391 | Tributary (branch) retinal vein occlusion, unspecified eye, with retinal revascularization |
| H34.8392 | Tributary (branch) retinal vein occlusion, unspecified eye, stable |
LUCENTIS ICD-10-CM Coding
These tables are provided for informational purposes only. Many payers will not accept unspecified codes. If you use an unspecified code, please check your payer. Correct coding is the responsibility of the provider.
Please visit CMS.gov or other payers’ websites to obtain additional guidance on their processes related to billing and coding for single-use vials and wastage.
Codes for Diabetic Macular Edema (DME)
Codes for Macular Edema Following Retinal Vein Occlusion (RVO)
Codes for Wet-Age Related Macular Degeneration (wet AMD)
Codes for Diabetic Retinopathy (Non Proliferative DR [NPDR] and Proliferative DR [PDR]) With DME
Codes for Myopic Choroidal Neovascularization (mCNV)
Appeals
If your office has prescribed LUCENTIS but your patient’s insurer has denied coverage, you can appeal that decision. LUCENTIS Access Solutions might be able to help you as you resolve the situation. Here is what you can do:
- Understand why the request or claim has been denied. This should be in the insurer’s letter of denial or the patient’s Explanation of Benefits (EOB) letter.
- Contact LUCENTIS Access Solutions for guidance as you put together an appeal. Use these resources to help you gather the documents and information you need for a successful appeal.
- Complete and submit the
required forms and documents to the insurer before the appeal
deadline. LUCENTIS Access Solutions can provide information about
this process.
Latest Updates
Form:
Statement of Medical Necessity (SMN)
Form:
Patient Authorization and Notice of Release of Information (PAN)