Effective with date of service Aug. 21, 2023, NC Medicaid Direct and NC Medicaid Managed Care cover aflibercept injection, for intravitreal use (Eylea HD) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J3590 - Unclassified biologics.
Strength/Package Size: Injection: 8 mg (0.07 mL of 114.3 mg/mL solution) in a single-dose vial
Aflibercept injection, for intravitreal use is indicated for the treatment of patients with:
- Neovascular (Wet) Age-Related Macular Degeneration (nAMD)
- Diabetic Macular Edema (DME)
- Diabetic Retinopathy (DR)
Recommended Dose:
Neovascular (Wet) Age-Related Macular Degeneration (nAMD)
The recommended dose for Eylea HD is 8 mg (0.07 mL of 114.3 mg/mL solution) administered by intravitreal injection every four weeks (approximately every 28 days +/- 7 days) for the first three doses, followed by 8 mg (0.07 mL of 114.3 mg/mL solution) via intravitreal injection once every 8 to 16 weeks, +/- 1 week.
Diabetic Macular Edema (DME)
The recommended dose for Eylea HD is 8 mg (0.07 mL of 114.3 mg/mL solution) administered by intravitreal injection every four weeks (approximately every 28 days +/- 7 days) for the first three doses, followed by 8 mg (0.07 mL of 114.3 mg/mL solution) via intravitreal injection once every 8 to 16 weeks, +/- 1 week.
Diabetic Retinopathy (DR)
The recommended dose for Eylea HD is 8 mg (0.07 mL of 114.3 mg/mL solution) administered by intravitreal injection every four weeks (approximately every 28 days +/- 7 days) for the first three doses, followed by 8 mg (0.07 mL of 114.3 mg/mL solution) via intravitreal injection once every 8 to 12 weeks, +/- 1 week.
See full prescribing information for further detail.
For Medicaid Billing
The ICD-10-CM diagnosis codes required for billing are:
- Neovascular (Wet) Age-Related Macular Degeneration (nAMD):
- 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;
- H35.3221 - 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;
- H35.3231 - 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;
- Diabetic Macular Edema (DME):
- E08.3111 Diabetes mellitus due to underlying condition diabetic retinopathy not otherwise specified with macular edema, right eye;
- E08.3112 Diabetes mellitus due to underlying condition diabetic retinopathy not otherwise specified with macular edema, left eye;
- E08.3113 Diabetes mellitus due to underlying condition diabetic retinopathy not otherwise specified with macular edema, bilateral;
- 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;
- E08.3311 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;
- E08.3411 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;
- E08.3511 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;
- E08.37X1 Diabetes mellitus due to underlying condition diabetic retinopathy with macular edema resolved following treatment, right eye;
- E08.37X2 Diabetes mellitus due to underlying condition diabetic retinopathy with macular edema resolved following treatment, left eye;
- E08.37X3 Diabetes mellitus due to underlying condition diabetic retinopathy with macular edema resolved following treatment, bilateral;
- E09.3111 Drug-induced diabetes mellitus diabetic retinopathy not otherwise specified with macular edema, right eye;
- E09.3112 Drug-induced diabetes mellitus diabetic retinopathy not otherwise specified with macular edema, left eye;
- E09.3113 Drug-induced diabetes mellitus diabetic retinopathy not otherwise specified with macular edema, bilateral;
- E09.3211 Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye;
- E09.3212 Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye;
- E09.3213 Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral;
- E09.3311 Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye;
- E09.3312 Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye;
- E09.3313 Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral;
- E09.3411 Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye;
- E09.3412 Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye;
- E09.3413 Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateral;
- E09.3511 Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye;
- E09.3512 Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eye;
- E09.3513 Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral;
- E09.37X1 Drug-induced diabetes mellitus diabetic retinopathy with macular edema resolved following treatment, right eye;
- E09.37X2 Drug-induced diabetes mellitus diabetic retinopathy with macular edema resolved following treatment, left eye;
- E09.37X3 Drug-induced diabetes mellitus diabetic retinopathy with macular edema resolved following treatment, bilateral;
- E10.3111 Type 1 diabetes mellitus with diabetic retinopathy not otherwise specified with macular edema, right eye;
- E10.3112 Type 1 diabetes mellitus with diabetic retinopathy not otherwise specified with macular edema, left eye;
- E10.3113 Type 1 diabetes mellitus with diabetic retinopathy not otherwise specified with macular edema, bilateral;
- 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;
- E10.3311 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;
- E10.3411 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;
- E10.3511 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;
- E10.37X1 Type 1 diabetes mellitus diabetic retinopathy with macular edema resolved following treatment, right eye;
- E10.37X2 Type 1 diabetes mellitus diabetic retinopathy with macular edema resolved following treatment, left eye;
- E10.37X3 Type 1 diabetes mellitus diabetic retinopathy with macular edema resolved following treatment, bilateral;
- E11.3111 Type 2 diabetes mellitus with diabetic retinopathy not otherwise specified with macular edema, right eye;
- E11.3112 Type 2 diabetes mellitus with diabetic retinopathy not otherwise specified with macular edema, left eye;
- E11.3113 Type 2 diabetes mellitus with diabetic retinopathy not otherwise specified with macular edema, bilateral;
- 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;
- E11.3311 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;
- E11.3411 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;
- E11.3511 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;
- E11.37X1 Type 2 diabetes mellitus diabetic retinopathy with macular edema resolved following treatment, right eye;
- E11.37X2 Type 2 diabetes mellitus diabetic retinopathy with macular edema resolved following treatment, left eye;
- E11.37X3 Type 2 diabetes mellitus diabetic retinopathy with macular edema resolved following treatment, bilateral;
- E13.3111 Other specified diabetes mellitus with unspecified diabetic retinopathy with macular edema, right eye;
- E13.3112 Other specified diabetes mellitus with unspecified diabetic retinopathy with macular edema, left eye;
- E13.3113 Other specified diabetes mellitus with unspecified diabetic retinopathy with macular edema, bilateral;
- 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;
- E13.3311 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;
- E13.3411 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;
- E13.3511 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;
- E13.37X1 Other specified diabetes mellitus diabetic retinopathy with macular edema resolved following treatment, right eye;
- E13.37X2 Other specified diabetes mellitus diabetic retinopathy with macular edema resolved following treatment, left eye;
- E13.37X3 Other specified diabetes mellitus diabetic retinopathy with macular edema resolved following treatment, bilateral;
- Diabetic Retinopathy (DR):
- E08.3111 Diabetes mellitus due to underlying condition diabetic retinopathy not otherwise specified with macular edema, right eye;
- E08.3112 Diabetes mellitus due to underlying condition diabetic retinopathy not otherwise specified with macular edema, left eye;
- E08.3113 Diabetes mellitus due to underlying condition diabetic retinopathy not otherwise specified with macular edema, bilateral;
- E08.3191 Diabetes mellitus due to underlying condition diabetic retinopathy not otherwise specified without macular edema, right eye;
- E08.3192 Diabetes mellitus due to underlying condition diabetic retinopathy not otherwise specified without macular edema, left eye;
- E08.3193 Diabetes mellitus due to underlying condition diabetic retinopathy not otherwise specified without macular edema, bilateral;
- 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;
- E08.3291 Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, right eye;
- E08.3292 Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, left eye;
- E08.3293 Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, bilateral;
- 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;
- E08.3391 Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema, right eye;
- E08.3392 Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema, left eye;
- E08.3393 Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema, bilateral;
- 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;
- E08.3491 Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema, right eye;
- E08.3492 Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema, left eye;
- E08.3493 Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema, bilateral;
- 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;
- E08.3521 Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye;
- E08.3522 Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye;
- E08.3523 Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral;
- E08.3531 Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye;
- E08.3532 Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye;
- E08.3533 Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral;
- E08.3541 Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye;
- E08.3542 Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye;
- E08.3543 Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral;
- E08.3551 Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, right eye;
- E08.3552 Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, left eye;
- E08.3553 Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, bilateral;
- E08.3591 Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema, right eye;
- E08.3592 Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema, left eye;
- E08.3593 Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema, bilateral;
- E08.37X1 Diabetes mellitus due to underlying condition diabetic retinopathy with macular edema resolved following treatment, right eye;
- E08.37X2 Diabetes mellitus due to underlying condition diabetic retinopathy with macular edema resolved following treatment, left eye;
- E08.37X3 Diabetes mellitus due to underlying condition diabetic retinopathy with macular edema resolved following treatment, bilateral;
- E09.3111 Drug-induced diabetes mellitus diabetic retinopathy not otherwise specified with macular edema, right eye;
- E09.3112 Drug-induced diabetes mellitus diabetic retinopathy not otherwise specified with macular edema, left eye;
- E09.3113 Drug-induced diabetes mellitus diabetic retinopathy not otherwise specified with macular edema, bilateral;
- E09.3191 Drug-induced diabetes mellitus diabetic retinopathy not otherwise specified without macular edema, right eye;
- E09.3192 Drug-induced diabetes mellitus diabetic retinopathy not otherwise specified without macular edema, left eye;
- E09.3193 Drug-induced diabetes mellitus diabetic retinopathy not otherwise specified without macular edema, bilateral;
- E09.3211 Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye;
- E09.3212 Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye;
- E09.3213 Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral;
- E09.3291 Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, right eye;
- E09.3292 Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eye;
- E09.3293 Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateral;
- E09.3311 Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye;
- E09.3312 Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye;
- E09.3313 Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral;
- E09.3391 Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, right eye;
- E09.3392 Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, left eye;
- E09.3393 Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, bilateral;
- E09.3411 Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye;
- E09.3412 Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye;
- E09.3413 Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateral;
- E09.3491 Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, right eye;
- E09.3492 Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, left eye;
- E09.3493 Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, bilateral;
- E09.3511 Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye;
- E09.3512 Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eye;
- E09.3513 Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral;
- E09.3521 Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye;
- E09.3522 Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye;
- E09.3523 Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral;
- E09.3531 Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye;
- E09.3532 Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye;
- E09.3533 Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral;
- E09.3541 Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye;
- E09.3542 Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye;
- E09.3543 Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral;
- E09.3551 Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy, right eye;
- E09.3552 Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy, left eye;
- E09.3553 Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy, bilateral;
- E09.3591 Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy without macular edema, right eye;
- E09.3592 Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eye;
- E09.3593 Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy without macular edema, bilateral;
- E09.37X1 Drug-induced diabetes mellitus diabetic retinopathy with macular edema resolved following treatment, right eye;
- E09.37X2 Drug-induced diabetes mellitus diabetic retinopathy with macular edema resolved following treatment, left eye;
- E09.37X3 Drug-induced diabetes mellitus diabetic retinopathy with macular edema resolved following treatment, bilateral;
- E10.3111 Type 1 diabetes mellitus with diabetic retinopathy not otherwise specified with macular edema, right eye;
- E10.3112 Type 1 diabetes mellitus with diabetic retinopathy not otherwise specified with macular edema, left eye;
- E10.3113 Type 1 diabetes mellitus with diabetic retinopathy not otherwise specified with macular edema, bilateral;
- E10.3191 Type 1 diabetes mellitus with diabetic retinopathy not otherwise specified without macular edema, right eye;
- E10.3192 Type 1 diabetes mellitus with diabetic retinopathy not otherwise specified without macular edema, left eye;
- E10.3193 Type 1 diabetes mellitus with diabetic retinopathy not otherwise specified without macular edema, bilateral;
- 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;
- E10.3291 Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, right eye;
- E10.3292 Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eye;
- E10.3293 Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateral;
- 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;
- E10.3391 Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, right eye;
- E10.3392 Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, left eye;
- E10.3393 Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, bilateral;
- 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;
- E10.3491 Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, right eye;
- E10.3492 Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, left eye;
- E10.3493 Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, bilateral;
- 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;
- E10.3521 Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye;
- E10.3522 Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye;
- E10.3523 Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral;
- E10.3531 Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye;
- E10.3532 Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye;
- E10.3533 Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral;
- E10.3541 Type 1 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye;
- E10.3542 Type 1 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye;
- E10.3543 Type 1 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral;
- E10.3551 Type 1 diabetes mellitus with stable proliferative diabetic retinopathy, right eye;
- E10.3552 Type 1 diabetes mellitus with stable proliferative diabetic retinopathy, left eye;
- E10.3553 Type 1 diabetes mellitus with stable proliferative diabetic retinopathy, bilateral;
- E10.3591 Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema, right eye;
- E10.3592 Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eye;
- E10.3593 Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema, bilateral;
- E10.37X1 Type 1 diabetes mellitus diabetic retinopathy with macular edema resolved following treatment, right eye;
- E10.37X2 Type 1 diabetes mellitus diabetic retinopathy with macular edema resolved following treatment, left eye;
- E10.37X3 Type 1 diabetes mellitus diabetic retinopathy with macular edema resolved following treatment, bilateral;
- E11.3111 Type 2 diabetes mellitus with diabetic retinopathy not otherwise specified with macular edema, right eye;
- E11.3112 Type 2 diabetes mellitus with diabetic retinopathy not otherwise specified with macular edema, left eye;
- E11.3113 Type 2 diabetes mellitus with diabetic retinopathy not otherwise specified with macular edema, bilateral;
- E11.3191 Type 2 diabetes mellitus with diabetic retinopathy not otherwise specified without macular edema, right eye;
- E11.3192 Type 2 diabetes mellitus with diabetic retinopathy not otherwise specified without macular edema, left eye;
- E11.3193 Type 2 diabetes mellitus with diabetic retinopathy not otherwise specified without macular edema, bilateral;
- 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;
- E11.3291 Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, right eye;
- E11.3292 Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eye;
- E11.3293 Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateral;
- 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;
- E11.3391 Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, right eye;
- E11.3392 Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, left eye;
- E11.3393 Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, bilateral;
- 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;
- E11.3491 Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, right eye;
- E11.3492 Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, left eye;
- E11.3493 Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, bilateral;
- 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;
- E11.3521 Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye;
- E11.3522 Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye;
- E11.3523 Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral;
- E11.3531 Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye;
- E11.3532 Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye;
- E11.3533 Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral;
- E11.3541 Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye;
- E11.3542 Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye;
- E11.3543 Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral;
- E11.3551 Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, right eye;
- E11.3552 Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, left eye;
- E11.3553 Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, bilateral;
- E11.3591 Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, right eye;
- E11.3592 Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eye;
- E11.3593 Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, bilateral;
- E11.37X1 Type 2 diabetes mellitus diabetic retinopathy with macular edema resolved following treatment, right eye;
- E11.37X2 Type 2 diabetes mellitus diabetic retinopathy with macular edema resolved following treatment, left eye;
- E11.37X3 Type 2 diabetes mellitus diabetic retinopathy with macular edema resolved following treatment, bilateral;
- E13.3111 Other specified diabetes mellitus with unspecified diabetic retinopathy with macular edema, right eye;
- E13.3112 Other specified diabetes mellitus with unspecified diabetic retinopathy with macular edema, left eye;
- E13.3113 Other specified diabetes mellitus with unspecified diabetic retinopathy with macular edema, bilateral;
- E13.3191 Other specified diabetes mellitus with unspecified diabetic retinopathy without macular edema, right eye;
- E13.3192 Other specified diabetes mellitus with unspecified diabetic retinopathy without macular edema, left eye;
- E13.3193 Other specified diabetes mellitus with unspecified diabetic retinopathy without macular edema, bilateral;
- 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;
- E13.3291 Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, right eye;
- E13.3292 Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eye;
- E13.3293 Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateral;
- 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;
- E13.3391 Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, right eye;
- E13.3392 Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, left eye;
- E13.3393 Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, bilateral;
- 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;
- E13.3491 Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, right eye;
- E13.3492 Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, left eye;
- E13.3493 Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, bilateral;
- 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;
- E13.3521 Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye;
- E13.3522 Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye;
- E13.3523 Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral;
- E13.3531 Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye;
- E13.3532 Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye;
- E13.3533 Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral;
- E13.3541 Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye;
- E13.3542 Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye;
- E13.3543 Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral;
- E13.3551 Other specified diabetes mellitus with stable proliferative diabetic retinopathy, right eye;
- E13.3552 Other specified diabetes mellitus with stable proliferative diabetic retinopathy, left eye;
- E13.3553 Other specified diabetes mellitus with stable proliferative diabetic retinopathy, bilateral;
- E13.3591 Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, right eye;
- E13.3592 Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eye;
- E13.3593 Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, bilateral;
- E13.37X1 Other specified diabetes mellitus diabetic retinopathy with macular edema resolved following treatment, right eye;
- E13.37X2 Other specified diabetes mellitus diabetic retinopathy with macular edema resolved following treatment, left eye;
- E13.37X3 Other specified diabetes mellitus diabetic retinopathy with macular edema resolved following treatment, bilateral
- Providers must bill with HCPCS code: J3590 - Unclassified biologics
- One Medicaid unit of coverage is: 1 mg
- The maximum reimbursement rate per unit is: $354.37500
- Providers must bill 11-digit NDCs and appropriate NDC units. The NDCs are: 61755-0050-00, 61755-0050-01
- The NDC units should be reported as "UN1"
- For additional information, refer to the January 2012, Special Bulletin, National Drug Code Implementation Update.
- For additional information regarding NDC claim requirements related to the PADP, refer to the PADP Clinical Coverage Policy 1B, Attachment A, H.7 on NC Medicaid's website.
- Providers shall bill their usual and customary charge for non-340B drugs.
- PADP reimburses for drugs billed for Medicaid beneficiaries by 340B participating providers who have registered with the Office of Pharmacy Affairs (OPA). Providers billing for 340B drugs shall bill the cost that is their actual acquisition cost. Providers shall indicate that a drug was purchased under a 340B purchasing agreement by appending the "UD" modifier on the drug detail.
- The fee schedule for the PADP is available on the NC Medicaid Fee Schedule & Covered Code portal.
ICD-10-CM Manual. American Medical Association, 2023 manual.
*Information current as of Sept. 19, 2023, and is not a substitute for professional judgment. For full prescribing information, please refer to current package insert or other appropriate sources prior to making clinical judgments.
Contact
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