Biosimilar aflibercept-boav (Eydenzelt) injection, billed per 1 milligram

Aflibercept-boav (Eydenzelt) is a biosimilar to the reference product aflibercept (Eylea), functioning as a vascular endothelial growth factor (VEGF) trap administered via intravitreal injection. This code is billed per 1 mg of the biosimilar, used in the treatment of retinal neovascular conditions. As a biosimilar, it is FDA-approved as interchangeable with the reference biologic under specific regulatory designations.

This code applies when aflibercept-boav is administered intravitreally for conditions such as neovascular (wet) age-related macular degeneration (nAMD), diabetic macular edema (DME), diabetic retinopathy, or macular edema following retinal vein occlusion. Standard dosing is 2 mg (2 units of this code) per injection session, though documentation should confirm the exact dose administered. Supporting documentation should include the drug name, lot number, dose in mg, route of administration, and the treated eye.

• Do not report this code interchangeably with the reference product aflibercept (Eylea) code J0178; payers may audit for biosimilar substitution and require the specific biosimilar HCPCS code when the biosimilar is dispensed.
• Bill units based on the actual mg administered (e.g., a 2 mg injection = 2 units); undercoding or overcoding units is a common error with per-mg drug codes.
• Verify individual payer biosimilar coverage policies, as some payers may require prior authorization or step therapy documentation confirming the biosimilar was dispensed rather than the reference biologic before reimbursing this code.