Eylea (aflibercept) is billed under J0178 ↗ for intravitreal injections. Ophthalmology clinics frequently face denials due to missing laterality modifiers (RT/LT) or incorrect unit counts.
Unit Calculation for Eylea (J0178)
The HCPCS code J0178 ↗ is defined as "Injection, aflibercept, 1 mg".
The standard dose per eye is 2 mg. If administering to one eye, bill 2 units. If administering bilaterally (both eyes), bill 4 units.
| Drug | Code | Administered Dosage | Billing Units |
|---|---|---|---|
| Eylea | J0178 | 2 mg (One Eye) | 2 |
Crucial: Modifiers RT, LT, and 50
Medicare requires you to specify which eye was injected. You must append Modifier RT (Right eye) or LT (Left eye) to the surgical administration code (67028). If treating both eyes, follow your specific MAC's guidelines on using Modifier 50 vs separate RT/LT lines.
Administration Edits
Bill CPT 67028 ↗ (Intravitreal injection of a pharmacologic agent). Ensure your NCCI edit checks are clear if billing a concurrent eye exam (e.g., 92012 or 99213).