HCPCS
J0179
1 mg = 1 unit
Phase 1
Identify what you're billing
Confirm the right code, dose, and NDC before building the claim.
Beovu in the anti-VEGF landscape FDA verified 2026
Beovu is the smallest molecule in the intravitreal anti-VEGF class, but its post-2020 safety profile keeps it niche.
Beovu (brolucizumab-dbll) is a humanized single-chain antibody fragment (scFv) targeting all isoforms of VEGF-A. At ~26 kDa, it is the smallest molecule in the intravitreal anti-VEGF class — smaller than ranibizumab (Fab, ~48 kDa) and far smaller than aflibercept (115 kDa) or faricimab (~150 kDa). The small-molecule design enables a high molar dose (6 mg in 0.05 mL at 120 mg/mL) and supported approval for q8–12 week maintenance dosing.
After commercial launch, however, the post-marketing safety signal for intraocular inflammation (IOI), retinal vasculitis (RV), and retinal vascular occlusion (RO) substantially limited Beovu's market position. It now occupies a low-single-digit minority of the US intravitreal anti-VEGF market, used primarily in patients who have failed aflibercept and faricimab and need an alternative mechanism, or where extended q12wk dosing is critical and the prescriber accepts the safety trade-off.
| Brand | Generic | J-code | Mechanism | Position |
|---|---|---|---|---|
| Beovu | brolucizumab-dbll | J0179 |
scFv anti-VEGF-A (~26 kDa) | Niche — safety baggage limits use |
| Eylea | aflibercept | J0178 |
VEGF-Trap (115 kDa) | Historical workhorse; biosimilars eroding share |
| Eylea HD | aflibercept 8 mg | J0177 |
High-dose aflibercept | Premium durability play (up to 20-week intervals) |
| Lucentis | ranibizumab | J2778 |
Fab anti-VEGF-A (~48 kDa) | Declining; biosimilars dominate |
| Vabysmo | faricimab | J2777 |
Bispecific anti-VEGF-A + anti-Ang-2 | Fastest-growing; durable q16wk |
| Avastin (off-label) | bevacizumab | J9035 / Q5126 |
Full mAb anti-VEGF-A (149 kDa) | Cheapest; default first-line per most payers |
Disambiguation rule of thumb: if the chart says "Beovu," "brolucizumab," "6 mg," or
"0.05 mL at 120 mg/mL," bill
J0179 × 6 units. Do not confuse with faricimab
(J2777, Vabysmo, also a 6 mg dose but a bispecific antibody). The active ingredient in the
chart is the disambiguator — both drugs share a 6 mg dose and similar dosing intervals, but they are
billed under different J-codes.
Database mapping note. Some commercial coding databases historically mismapped J0179 to
faricimab/Vabysmo. The correct mapping is:
J0179 = brolucizumab-dbll = Beovu;
J2777 = faricimab-svoa = Vabysmo. Always verify against the CMS HCPCS quarterly file.
Dosing per indication FDA label verified 2026
From FDA prescribing information (BLA 761125). Two indications.
| Indication | Loading | Maintenance | Per dose |
|---|---|---|---|
| Wet AMD (wAMD) | 6 mg every 4 weeks (monthly) × 3 doses | Every 8–12 weeks based on disease activity | 6 mg / 6 units |
| Diabetic Macular Edema (DME) | 6 mg every 6 weeks (~every 39–45 days) × 5 doses | Every 8–12 weeks based on disease activity | 6 mg / 6 units |
Durability data: in the KESTREL/KITE pivotal DME trials, approximately 50–55% of
Beovu-treated eyes maintained q12wk dosing through year 1. In the wAMD HAWK/HARRIER trials, ~50–55%
of patients were maintained on q12wk dosing through year 1 as well.
Dose math — J0179 units
# Beovu billable units (1 mg = 1 unit)
6 mg dose = 6 units
# Q2 2026 Medicare reimbursement (ASP+6%)
1 mg = $353.069
6 mg dose (per eye) = $2,118.41
After ~2% sequestration = ~$2,076
# Bilateral same-day (per encounter, two eyes)
12 mg total drug billed = 12 units of J0179
Drug-only payment (pre-seq) = ~$4,236.83
Plus 2x CPT 67028 = + admin fee per eye
Pediatric
Per FDA label: "Safety and effectiveness of BEOVU in pediatric patients have not been established." No payer reviewed covers pediatric Beovu.
NDC reference FDA NDC Directory verified May 2026
| NDC (10-digit) | NDC (11-digit, claim form) | Package | Manufacturer |
|---|---|---|---|
0078-0827-61 |
00078-0827-61 |
6 mg / 0.05 mL single-dose vial kit (with filter needle) | Novartis |
0078-0827-60 |
00078-0827-60 |
6 mg / 0.05 mL single-dose prefilled syringe (PFS) | Novartis |
11-digit NDC required on most claim forms. Pad the labeler segment with a leading zero:
00078-0827-61. Use the
N4 qualifier in CMS-1500 Box 24A shaded area, with
the ML2 unit qualifier and quantity 0.05 (e.g., N400078082761ML20.05). Some
payer systems still accept generic ML with quantity 0.05; ML2 is the more precise qualifier
for the Beovu package configuration.
Storage / handling: Refrigerate at 2–8°C in the original carton, protected from light. Beovu may be stored at 20–25°C for up to 24 hours before administration. Do not freeze. Inspect for particulates and discoloration prior to administration. Both the vial kit and the PFS deliver the same 6 mg / 0.05 mL dose.
Phase 2
Code the claim
CPT 67028 + per-eye laterality + NCCI bundling pitfalls + safety attestation.
CPT 67028 & bilateral rules CPT verified May 2026
Intravitreal injections have unique laterality rules — per-eye billing, RT/LT preferred over modifier 50.
| Code | Description | Notes |
|---|---|---|
67028 |
Intravitreal injection of a pharmacologic agent (separate procedure) | Always pair with the J0179 drug line on the same claim. Append RT or LT for laterality. |
Bilateral same-day injections — RT/LT, not modifier 50
For bilateral Beovu injections on the same date of service, most payers require two separate line items:
- Line 1:
67028-RT, 1 unit, full fee - Line 2:
67028-LT, 1 unit, full fee
Some commercial payers accept the alternative single-line format with modifier 50:
67028-50, 1 unit, fee doubled
Per AAPC: "It is important to check with individual payers as some may require the procedure to be billed on two separate lines with -RT and -LT modifiers instead of using -50." Modifier 50 is not preferred for retina; RT/LT is the safer default.
Drug billing for bilateral: bill J0179 twice as well — one drug line per eye, each with
the matching RT or LT modifier. Each eye gets 6 units of J0179 + 1 unit of 67028. Some payers also require
RT/LT on the J0179 drug line itself; verify per-payer.
Bilateral Beovu carries doubled IOI/RV/RO risk. Most retina specialists avoid same-day
bilateral Beovu injections specifically to limit exposure if an inflammatory event occurs. Stagger
bilateral Beovu treatments by at least one week. Some payers cite this practice expectation in PA criteria.
Modifiers CMS verified May 2026
RT / LT — required for laterality
Append RT (right eye) or LT (left eye) to the 67028 admin line, and on most payers' policies, to the J0179 drug line as well. Without laterality, payer systems can't reconcile bilateral claims and will deny one or both lines. The RT/LT modifier must match the laterality character in the ICD-10 diagnosis.
JZ — required when no drug discarded
Effective July 1, 2023, CMS requires the JZ modifier on all single-dose container claims when no drug is discarded. Beovu's 0.05 mL package (vial kit or PFS) is sized to the full 6 mg dose, so the entire content is administered with zero billable wastage. JZ applies to nearly every Beovu claim.
JW — rarely applies
Use JW only if ≥1 billable unit (1 mg) was actually wasted. Because the package is sized to the dose, this is uncommon and primarily occurs in rare partial-administration scenarios. If you do bill JW, the wasted units are reported on a separate line from the administered units, with documentation in the medical record.
Modifier 25 — same-day E/M
Append modifier 25 to the E/M code when a significant, separately identifiable E/M service is performed on the same day as the injection. Routine pre-injection workup is bundled. New clinical concerns (suspected IOI, sudden vision change, treatment-decision visits) qualify; routine "see how the eye looks before the shot" does not.
NCCI bundling — OCT, fundus photo, and 67028 NCCI verified May 2026
Ophthalmology-specific bundling that drives a large share of retina claim denials.
CMS National Correct Coding Initiative (NCCI) bundles several diagnostic services with 67028 when performed same-day:
| Code | Service | NCCI relationship to 67028 |
|---|---|---|
92133 | SCODI optic nerve (OCT) | Bundled same-day; XU/59 unbundling possible with documentation |
92134 | SCODI retina (OCT) | Bundled same-day; XU/59 unbundling possible with documentation |
92250 | Fundus photography | Bundled same-day; XU/59 unbundling possible with documentation |
| Established-pt E/M (99211–99215) | Office visit | Bundled; use modifier 25 if separately identifiable |
| Eye visit codes (92012, 92014) | Comprehensive eye exam | Not bundled with 67028 by NCCI |
92235 / 92240 | FA / ICG angiography | Generally separately reimbursable when medically necessary; document indication (e.g., suspected occlusive vasculitis) |
Common denial: Billing OCT (92134) on the same date as 67028 without a modifier. NCCI will
deny the bundled service. To unbundle, append
XU or 59 to the OCT line, with
documentation in the medical record showing the OCT informed a treatment decision distinct from the
injection itself (e.g., evaluating disease progression for an interval-extension decision, or evaluating
suspected post-injection inflammation). Without proper documentation, the unbundling is audit-vulnerable.
Eye visit codes (92012, 92014) are NOT bundled with 67028, so they're often the better choice for the visit portion of an injection encounter. FA/ICG angiography, when used to evaluate suspected post-Beovu retinal vasculitis or vascular occlusion, is medically necessary and separately reportable — this is a Beovu-specific scenario worth flagging for the coder.
Safety profile & ASRS context FDA label + ASRS Apr 2020 / June 2020
Beovu's post-marketing safety signal materially shapes prior authorization, prescribing, and informed consent. Coders should know the context.
FDA Warnings & Precautions (no boxed warning, but prominent):
- Endophthalmitis and retinal detachments — class effect of intravitreal injection
- Retinal vasculitis (RV) and/or retinal vascular occlusion (RO) — Beovu-specific signal added June 2020
- Intraocular inflammation (IOI) — Beovu-specific signal added June 2020
- Increase in intraocular pressure — class effect
- Thromboembolic events — class effect (low arterial thromboembolic event rate observed in pivotal trials)
Timeline of the safety signal
- October 2019: FDA approves Beovu for wAMD (BLA 761125). Original label includes the standard intravitreal injection class warnings (endophthalmitis, retinal detachment, IOP, thromboembolic events).
- February–April 2020: ASRS receives multiple post-marketing reports of retinal vasculitis, including occlusive cases.
- April 2020: ASRS Research and Safety in Therapeutics (ReST) Committee issues a Member Alert citing 26 cases of retinal vasculitis — many occlusive — in 25 patients, with approximately 88% in women.
- June 2020: FDA approves an updated Beovu label adding explicit Warnings & Precautions for IOI, RV, and RO. Updated label cites approximately 4% IOI incidence and 1% retinal artery occlusion incidence in pivotal data analysis.
- June 2022: FDA approves Beovu for diabetic macular edema (DME), with ongoing W&P language for IOI/RV/RO.
- 2021–2024: Real-world studies report rates of IOI and IOI-with-occlusive-vasculitis ranging approximately 8.75–10.08 events per 10,000 injections, generally below the pivotal-trial 4% rate but with severe outcomes (vision loss) when they occur.
Mechanism hypothesis
The leading hypothesis attributes the IOI/RV/RO signal to Beovu's small scFv structure and the pre-existing anti-drug antibody (ADA) population in some patients. ADA prevalence is reported to be higher for brolucizumab than for other anti-VEGFs, contributing to immune-mediated intraocular inflammation in susceptible patients. Predominance in women (~88% of ASRS-reported cases) remains incompletely explained.
How this affects the coder / biller
- Heavy step therapy in payer policies (see payer policy snapshot) — expect 2 prior anti-VEGF failures as the default PA threshold.
- Risk-benefit attestation — some payers (Carelon/Anthem, Moda) require explicit prescriber attestation acknowledging IOI/RV/RO risk and confirming informed consent.
- Ophthalmologist-only prescribing — some payer policies restrict Beovu to retina specialists / ophthalmologists rather than general physicians.
- Bilateral same-day caution — standard practice is to stagger bilateral Beovu by at least one week.
- Post-injection FA/ICG angiography — when used to evaluate suspected occlusive vasculitis, is medically necessary and separately reportable from 67028; document the suspicion clearly.
- Active product liability litigation exists; multiple plaintiff firms recruit Beovu vision-loss cases. Document informed consent meticulously.
Sources: ASRS Research and Safety in Therapeutics (ReST) Committee; FDA Drugs@FDA — BLA 761125; published real-world safety analyses in Ophthalmology Retina, JAMA Ophthalmology, and the IRIS Registry post-marketing analyses.
ICD-10-CM diagnosis codes FY2026 verified May 2026
Use the most specific code supported by the encounter documentation.
| ICD-10 | Description | Use for |
|---|---|---|
H35.32xx | Exudative age-related macular degeneration | Wet AMD (wAMD); 5th & 6th characters specify laterality and stage (active CNV vs scar vs inactive) |
E11.311 | T2DM with unspecified diabetic retinopathy with macular edema | DME in T2DM, retinopathy severity not specified |
E11.321 | T2DM with mild non-proliferative diabetic retinopathy with macular edema | Mild NPDR + DME in T2DM |
E11.331 | T2DM with moderate non-proliferative diabetic retinopathy with macular edema | Moderate NPDR + DME in T2DM |
E11.341 | T2DM with severe non-proliferative diabetic retinopathy with macular edema | Severe NPDR + DME in T2DM |
E11.351 | T2DM with proliferative diabetic retinopathy with macular edema | PDR + DME in T2DM |
E10.311 / E10.321 / E10.331 / E10.341 / E10.351 | T1DM equivalents of the above | DME in T1DM, by retinopathy severity |
H35.81 | Retinal edema | Adjunct dx; not standalone for J0179 |
Pair the diagnosis with the laterality modifier on the procedure line. ICD-10 codes carry
their own laterality character (e.g., H35.3211 = wAMD right eye stage 1); the RT/LT on 67028 must match.
Mismatch between Dx laterality and procedure laterality is a denial trigger.
Beovu is NOT FDA-approved for: diabetic retinopathy without DME, retinal vein occlusion
(RVO), or myopic CNV. If the chart diagnosis is RVO (H34.81xx) or DR without DME, J0179 is off-label and
most payers will deny. Eylea HD, Eylea, Lucentis, and Vabysmo all have broader retinal indications.
Site of care & place of service Verified May 2026
Beovu is administered in-office or in an ASC. Home administration does not apply for intravitreal injections.
Intravitreal injections must be performed by an ophthalmologist or qualified retina specialist in a setting with sterile injection capability. Home administration is not a valid pathway for Beovu, so home-infusion HCPCS codes (S9329, S9379, 99601, G0089) do not apply. The only legitimate sites of care are physician office, ophthalmology-based ASC, and hospital outpatient.
| Setting | POS | Claim form | Electronic |
|---|---|---|---|
| Physician / retina office | 11 | CMS-1500 | 837P |
| Ambulatory surgery center (ophth ASC) | 24 | CMS-1500 | 837P |
| Hospital outpatient | 22 | UB-04 / CMS-1450 | 837I |
| On-campus hospital outpatient | 19 | UB-04 / CMS-1450 | 837I |
Payer site-of-care steering
Both UnitedHealthcare and Aetna apply site-of-care utilization management to ophthalmology anti-VEGF injections, generally favoring office (POS 11) and ophth ASC (POS 24) over hospital outpatient (POS 19/22) due to higher facility fees. If your practice operates under a hospital's billing TIN, expect a payer challenge for hospital outpatient billing.
POS choice affects reimbursement. Office (POS 11) and ASC (POS 24) generally pay at higher
physician-fee-schedule rates for the drug, while hospital outpatient (POS 19/22) bills under OPPS/APC
bundling rules with separate facility-fee considerations. Confirm your payer's preferred site before
scheduling.
Claim form field mapping Novartis 2025 + Retina Today
CMS-1500 / 837P (physician office, ASC; POS 11/24).
| Information | CMS-1500 box | Notes |
|---|---|---|
| NDC qualifier + 11-digit NDC + UoM + qty | 24A shaded area | Format: N400078082761ML20.05 (vial kit) or N400078082760ML20.05 (PFS) |
| HCPCS J0179 + RT/LT + JZ | 24D (drug line) | One unit count = 6 (mg) |
| Drug units | 24G | 6 |
| CPT 67028 + RT/LT | 24D (admin line) | One unit per eye |
| ICD-10 | 21 | Specific H35.32xx (wAMD) or E1x.3x1 (DME) |
| Dates of service | 24A | Same date for drug + admin lines |
| NPI | 17b | Rendering provider (ophthalmologist / retina specialist) |
| PA number (when required) | 23 | Required by virtually all major payers for J0179 |
Source: Retina Today — How to Create Clean Claims; Novartis Beovu billing & coding materials (provided through HCP portal).
Phase 3
Get paid
Step therapy is heavy. Document prior failures and risk-benefit attestation up front.
Payer policy snapshot Reviewed May 2026
Beovu sits in the least-preferred tier of intravitreal anti-VEGFs at most major payers due to the post-2020 IOI/RV/RO safety profile.
| Payer | PA? | Step therapy? | Quantity limit | Tier position |
|---|---|---|---|---|
| UnitedHealthcare Ophth VEGF Inhibitors policy |
Yes | Yes — bevacizumab + at least one of (aflibercept / aflibercept-biosimilar / faricimab) trial required | FDA-label dosing | Least preferred |
| Aetna CPB 0701; MA Ref 2507-A |
Yes | Yes — bevacizumab + aflibercept trial; some plans add faricimab step | FDA-label dosing | Non-preferred |
| Carelon / Anthem VEGF Inhibitors policy |
Yes | Yes — 2 prior anti-VEGF failures + explicit risk-benefit attestation re: IOI/RV/RO | FDA-label dosing | Least preferred |
| BCBS (most plans) e.g., Blue Shield CA |
Yes | Generally yes — bevacizumab + aflibercept or faricimab failure documented | FDA-label dosing | Least preferred |
| Moda Health Anti-VEGF policy |
Yes | Yes — 2 prior anti-VEGFs + ophthalmologist-only prescribing + IOI/RV/RO consent attestation | FDA-label dosing | Least preferred |
Step therapy is the dominant Beovu UM mechanism. Unlike the typical anti-VEGF step-therapy
flow where Avastin alone unlocks aflibercept or faricimab, Beovu sits an additional tier deeper. Plan on
documenting at least two prior anti-VEGF failures or intolerances (most commonly
bevacizumab + aflibercept or biosimilar) before requesting Beovu authorization. Some payers add a third
step (faricimab) before approving Beovu.
Why Beovu sits in the least-preferred tier
Three factors:
- Safety: the post-2020 IOI/RV/RO signal — payers cite ASRS guidance directly.
- Cost vs. alternatives: Beovu's ASP is comparable to faricimab and aflibercept HD; it is not a cost-saving choice that would justify earlier placement.
- Equivalent or better alternatives exist: faricimab (Vabysmo, q16wk) and aflibercept HD (Eylea HD, up to q20wk) deliver durability without the same safety signal.
What to document for Beovu PA approval
- Date(s) and number of prior bevacizumab injections, with measured response (visual acuity, OCT central subfield thickness)
- Date(s) and number of prior aflibercept (Eylea or Eylea HD) injections, with measured response
- If applicable, date(s) and number of prior faricimab (Vabysmo) injections, with measured response
- Documented intolerance, contraindication, or treatment failure on each prior anti-VEGF
- Risk-benefit discussion with the patient, including IOI/RV/RO risk, documented in the chart
- Signed informed consent reflecting the IOI/RV/RO discussion (some payers require attestation language)
Medicare reimbursement CMS Q2 2026 (live)
Quarterly ASP from CMS Part B Drug Pricing File. Refreshes automatically each quarter.
Q2 2026 payment snapshot — J0179
Effective April 1 – June 30, 2026 · Based on 4Q25 ASP submissions
ASP + 6%
$353.069
per mg / per unit
6 mg dose
$2,118.41
6 units × ASP+6%
After sequestration
~$2,076
~2% reduction (actual paid)
Coverage
No NCD specific to Beovu. The relevant MAC billing & coding article is A52451 ("Billing and Coding: Ranibizumab and biosimilars, Aflibercept, Aflibercept HD, Brolucizumab-dbll, Faricimab-svoa..."). All MACs cover J0179 for FDA-approved on-label indications (wAMD and DME). Bill with a specific H35.32xx (wAMD) or E1x.3x1 (DME) ICD-10. Off-label use (RVO, DR without DME, mCNV) is generally not covered.
Code history
- C9050 — original temporary HCPCS for brolucizumab (Hospital OPPS pass-through), assigned shortly after FDA approval
- J0179 — permanent HCPCS, "Injection, brolucizumab-dbll, 1 mg," replaced C9050
Canonical code source: CMS HCPCS quarterly update file.
Patient assistance — Novartis & foundations Novartis verified May 2026
- Novartis Patient Assistance Foundation (NPAF): free drug for uninsured / underinsured patients meeting income requirements. 1-800-277-2254; fax 1-855-817-2711. Application portal at pap.novartis.com.
- Beovu Co-Pay Program (commercial only): commercial copay assistance for eligible commercially-insured patients. Excludes Medicare, Medicaid, Tricare, VA, and other federal program patients. Enrollment via pap.novartis.com.
- Independent foundations (Medicare patients): Good Days and HealthWell Foundation — macular degeneration / vascular & neovascular retinal disease funds. Verify open funds quarterly — foundation funds open and close based on donor support.
- Provider portal: Novartis HCP Beovu information available through beovu-hcp.com for benefits investigation submission.
Need to model what a specific patient will actually pay after copay assistance, deductible, coinsurance,
and OOP max? Run a CareCost Estimate — J0179 pre-loaded.
Phase 4
Fix problems
Step-therapy denials, off-label-indication denials, and risk-attestation denials are the top three.
Common denials & how to fix them
| Denial reason | Common cause | Fix |
|---|---|---|
| Wrong J-code (J2777 instead of J0179) | Beovu confused with faricimab/Vabysmo (both 6 mg, similar interval) | Verify active ingredient in chart. Beovu = brolucizumab = J0179. Vabysmo = faricimab = J2777. |
| Step therapy not met | Insufficient prior anti-VEGF documentation; payer requires 2 prior failures | Submit prior bevacizumab + aflibercept (or faricimab) trial documentation: dates, doses, OCT measurements, response data, intolerance/contraindication. |
| Off-label indication | Beovu billed for RVO, DR without DME, or mCNV (not FDA-approved) | Beovu is approved only for wAMD and DME. For other retinal indications, switch to an on-label agent (Eylea, Eylea HD, Vabysmo, Lucentis). |
| Risk-benefit attestation missing | Payer (Carelon, Moda, etc.) requires explicit IOI/RV/RO consent attestation | Submit signed attestation form and chart documentation of risk-benefit discussion. Include consent form documenting IOI/RV/RO disclosure. |
| Bundled diagnostic (OCT/fundus photo) | 92134/92250 billed same day as 67028 without modifier | Resubmit OCT/fundus photo line with modifier XU or 59 + medical-record documentation showing distinct medical necessity. |
| Laterality mismatch | RT/LT modifier doesn't match the ICD-10 laterality character | Match: H35.3211 (right eye) → 67028-RT + J0179-RT. Same date, same eye on every line. |
| Bilateral billed as modifier 50 | Payer requires RT/LT separate lines, not modifier 50 | Resubmit as two lines: 67028-RT + 67028-LT, full fee on each. Same for J0179 drug lines. |
| NDC format | 10-digit NDC submitted instead of 11-digit; missing N4 qualifier or wrong UoM | Use N400078082761ML20.05 format (vial kit) or N400078082760ML20.05 (PFS) in CMS-1500 Box 24A shaded area. |
| JZ missing | Single-dose vial / PFS claim without JZ modifier | Resubmit with JZ on the J0179 line. Required since 7/1/2023. |
| Prescriber type restriction | Beovu prescribed by non-ophthalmologist on a payer that restricts to retina specialists | Have a credentialed ophthalmologist / retina specialist prescribe and bill. Some payers (Moda, others) explicitly restrict. |
Frequently asked questions
What is the HCPCS code for Beovu?
Beovu (brolucizumab-dbll) is billed under HCPCS J0179 — "Injection, brolucizumab-dbll,
1 mg." Each milligram equals one billable unit, so the standard 6 mg intravitreal dose is billed as 6
units. Beovu is a single-chain antibody fragment (scFv) anti-VEGF-A — distinct in mechanism from
aflibercept (J0178/J0177), ranibizumab (J2778), and faricimab (J2777).
How many units do I bill for a Beovu dose?
Bill 6 units of J0179 per Beovu injection. The drug comes in a 6 mg / 0.05 mL
single-dose vial kit or prefilled syringe at 120 mg/mL. 1 mg = 1 unit; 6 mg = 6 units. The JZ modifier
applies to nearly every claim because the package is sized to the full 6 mg dose with zero discarded drug.
What is the administration code for Beovu?
CPT 67028 — "Intravitreal injection of a pharmacologic agent (separate procedure)." Bill
67028 with an RT (right eye) or LT (left eye) modifier. For bilateral same-day injections, most payers
require two separate line items with RT and LT, full fee on each — not modifier 50. The administration
code must be billed on the same claim as the J0179 drug line.
What is the safety controversy around Beovu?
In April 2020 the American Society of Retina Specialists (ASRS) Research and Safety in Therapeutics (ReST) Committee issued a safety alert after 26 cases of retinal vasculitis — many occlusive — were reported in 25 Beovu-treated patients (~88% women). In June 2020 the FDA approved an updated label adding explicit Warnings & Precautions for intraocular inflammation (IOI), retinal vasculitis (RV), and retinal vascular occlusion (RO). The updated label cites approximately 4% IOI and 1% retinal artery occlusion rates. Real-world rates have been reported at roughly 8.75–10.08 events per 10,000 injections. The mechanism hypothesis centers on Beovu's small scFv structure and high pre-existing anti-drug antibody (ADA) prevalence, contributing to immune-mediated inflammation. Most major payers cite ASRS guidance in their prior-authorization criteria.
Does Beovu require step therapy?
Yes — heavily. Most commercial and Medicare Advantage plans place Beovu in the least-preferred tier of intravitreal anti-VEGFs because of its post-2020 IOI/RV/RO safety signal. Typical pathway: documented trial or contraindication on bevacizumab (Avastin, off-label) first, then aflibercept (Eylea / Eylea HD or biosimilars Yesafili / Opuviz / Pavblu / Ahzantive / Enzeevu / Eydenzelt), often plus faricimab (Vabysmo), before Beovu is approved. Many policies require failure or intolerance of two prior anti-VEGFs. Some payers (e.g., Carelon/Anthem VEGF policy, Moda) also require an explicit risk-benefit attestation regarding IOI/RV/RO and limit prescribing to ophthalmologists.
What are the FDA-approved indications for Beovu?
Two indications: neovascular (wet) age-related macular degeneration (wAMD), approved October 2019 (BLA 761125), and diabetic macular edema (DME), approved June 2022. Pediatric use is not established. Beovu is not FDA-approved for diabetic retinopathy without DME, retinal vein occlusion, or myopic CNV.
What is the Medicare reimbursement for J0179?
Medicare Part B reimburses J0179 at ASP + 6%. Q2 2026 ASP+6% was
$353.069/mg, putting a 6 mg dose at approximately
$2,118.41 before sequestration. Sequestration (~2%) reduces actual paid to
roughly ASP + 4.3%. ASP is updated quarterly by CMS.
Does Beovu have biosimilars?
No. As of May 2026, no biosimilars exist for Beovu (brolucizumab). The aflibercept biosimilars (Yesafili/Q5155, Opuviz, Pavblu, Ahzantive, Enzeevu, Eydenzelt) reference the original Eylea 2 mg formulation; ranibizumab biosimilars (Byooviz, Cimerli, Ahzantive) reference Lucentis. Brolucizumab has no approved biosimilars in the US market.
Are 67028 and OCT (92133/92134) bundled by NCCI?
Yes. NCCI bundles 67028 with 92133/92134 (OCT scans) and 92250 (fundus photography) when performed same-day.
To unbundle, append modifier XU or 59 to the bundled code with documented
separate medical necessity (e.g., the OCT informed a treatment decision distinct from the injection itself,
or evaluated suspected post-injection inflammation). Without proper documentation and modifier, the
bundled service will deny.
How does Beovu compare to other anti-VEGF agents?
Beovu (brolucizumab-dbll, J0179) is the smallest anti-VEGF molecule available — a single-chain antibody fragment (scFv, ~26 kDa) targeting VEGF-A. Eylea/Eylea HD (aflibercept, J0178/J0177) is a VEGF-Trap fusion protein. Lucentis (ranibizumab, J2778) is a Fab fragment. Vabysmo (faricimab, J2777) is a bispecific anti-VEGF-A + anti-Ang-2. Avastin (bevacizumab, off-label, J9035/Q5126) is a full IgG. Beovu offers q8–12 week dosing durability comparable to aflibercept and faricimab, but its safety profile (IOI/RV/RO signal) has limited adoption to a low-single-digit minority of the US intravitreal anti-VEGF market.
Reference
Sources & methodology
Every claim on this page is sourced. Methodology and review history below.
Source documents
- DailyMed — BEOVU (brolucizumab-dbll) Prescribing Information
- FDA Drugs@FDA — BLA 761125 (brolucizumab-dbll)
- Novartis press releases — Beovu approvals and label updates
- ASRS — Research and Safety in Therapeutics (ReST) Committee
- CMS — Medicare Part B Drug ASP Pricing File
- CMS MCD Article A52451 — Anti-VEGF Billing & Coding (incl. brolucizumab-dbll)
- CMS — HCPCS quarterly update file
- UnitedHealthcare — Ophthalmologic VEGF Inhibitors policy
- Aetna CPB 0701 — VEGF Inhibitors for Ocular Indications
- Carelon / Anthem — VEGF Inhibitors clinical guideline
- Moda Health — Anti-VEGF policy
- Blue Shield of California — ophthalmologic VEGF inhibitors policy
- Retina Today — How to Create Clean Claims
- Retina Today — The Effect of Bilateral Rules on Retina Coding
- AAPC — CPT 67028
- CMS NCCI — National Correct Coding Initiative edit tables
- Novartis Patient Assistance Foundation (NPAF)
About this page
We maintain this page as a living reference. Medicare ASP pricing is bound to our underlying CareCost data layer and refreshes automatically when CMS publishes new quarterly files. Coding and policy content is reviewed at least quarterly and updated whenever a source document changes.
Found an error? Email hello@carecostestimate.com.
Refresh cadence
| Element | Cadence | How it's refreshed |
|---|---|---|
| Medicare ASP pricing | Quarterly | Auto-bound to CareCost ASP layer; updates on CMS file release. |
| Payer policies (UHC, Aetna, BCBS, Carelon, Moda) | Semi-annual | Manual review against published payer policy documents. |
| HCPCS / CPT / NCCI rules | Annual | Reviewed against CMS HCPCS quarterly files, AMA CPT releases, and NCCI edit updates. |
| NDC, dosing, FDA label | Event-driven | Tied to manufacturer document version + FDA label revision date. |
| Safety profile / ASRS context | Event-driven | Tied to FDA label revisions and ASRS / IRIS Registry post-marketing analyses. |
Reviewer
Pending SME review. This page is staff-authored from primary sources (FDA, CMS, manufacturer,
payer documents, ASRS — all linked above). Final review by our SME, Catherine Rose (CPC), is in
progress. Until that review is complete, treat this as a draft reference and verify each cited source for
high-stakes claims.
Change log
- — Initial publication. ASP data: Q2 2026. FDA label: post-2020 IOI/RV/RO update + June 2022 DME indication. Payer policies: UHC Ophth VEGF Inhibitors, Aetna CPB 0701 + MedB 2507-A, Carelon/Anthem VEGF, Moda Health, Blue Shield CA. ASRS Apr 2020 Member Alert context included.
Methodology
Every claim on this page is sourced inline. Pricing reflects the current CMS Part B Drug ASP Pricing File. Payer policies are read directly from each payer's published medical policy documents. We do not paraphrase from billing-software vendor blogs. When manufacturer guidance and payer policy conflict (as happens with bilateral injection coding and step-therapy rules), we surface the conflict rather than picking a side. For Beovu specifically, we surface the post-2020 IOI/RV/RO safety signal context prominently because it materially shapes payer policy, prescribing patterns, and informed-consent requirements that coders and billers must understand to work claims successfully.