For GA, secondary to AMD

NAVIGATING BILLING AND CODING

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information for SYFOVRE
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Refer to the tools and tips below for information on billing, coding, and submitting claims for SYFOVRE.

Find the relevant codes to file your claim

ICD-10-CM Codes for GA1

Nonexudative AMD

Advanced atrophic without subfoveal involvement

  • Right eye: H35.3113
  • Left eye: H35.3123
  • Bilateral: H35.3133

Advanced atrophic with subfoveal involvement

  • Right eye: H35.3114
  • Left eye: H35.3124
  • Bilateral: H35.3134

CPT Code2

67028: Intravitreal injection of a pharmacologic agent, separate procedure

Modifiers

  • Modifier
  • Description
  • -LT
  • Left eye
  • -RT
  • Right eye
  • -50
  • Bilateral

HCPCS Code3

Permanent J-codea,b

J2781: Injection, pegcetacoplan, intravitreal, 1 mg
Bill 15 units for each SYFOVRE injection
The JZ modifier is required. Please check with your patient’s health plan for specific requirements

Site of care

Physician office and hospital outpatient

NDC4

10-digit NDC: 73606-020-01

11-digit NDC: 73606-0020-01c

The coding information is provided for informational purposes only, is subject to change, and should not be a substitute for independent clinical judgment when selecting diagnosis and/or reimbursement codes. Codes listed above may not be exhaustive of those required by payers.

aJ2781 is a permanent, product-specific code assigned by CMS. Bill 15 units for each SYFOVRE injection.
bDose descriptor is assigned by CMS; please see full Prescribing Information for approved dosing.
cThe 11-digit NDC is derived from the 10-digit code. Many payers require the use of the 11-digit code.

Helpful tools to support access and reimbursement

Billing and Coding Guide

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J-code Reference Card

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Access and Reimbursement Guide 

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Sample CMS-1500 Claim Form: Physician Office

The sample claim form provided below is for illustrative purposes only. It is always the provider’s responsibility to determine the appropriate healthcare setting and to submit true and correct claims for the products and services rendered. Providers should contact third-party payers for specific information on their coding, coverage, payment policies, and fee schedules.

Click the boxes below to learn more

NOTE: Payers may vary in their specific billing and coding requirements. Please check with your patient’s health plan to ensure you are providing accurate and complete information.

Discover our access and reimbursement resources.

NAVIGATE TO RESOURCES

AMD=age-related macular degeneration; CPT=Current Procedural Terminology; GA=geographic atrophy; HCPCS=Healthcare Common Procedure Coding System; ICD-10-CM=International Classification of Diseases, Tenth Revision, Clinical Modification; NDC=National Drug Code.

References: 1. Lum F, Repka MX, Vicchrilli S. How to use the ICD-10 codes for age-related macular degeneration. EyeNet Magazine. 2017;9:61-62. 2. Coding for injectable drugs. American Academy of Ophthalmology. Accessed August 16, 2024. https://www.aao.org/practice-management/coding/injectable-drugs 3. Centers for Medicare & Medicaid Services (CMS) Healthcare Common Procedure Coding System (HCPCS) application summaries and coding recommendations. Centers for Medicare & Medicaid Services. Accessed August 16, 2024. https://www.cms.gov/files/document/2023-hcpcs-application-summary-quarter-2-2023-drugs-and-biologicals.pdf 4. Syfovre. Prescribing information. Apellis Pharmaceuticals, Inc; 2023.

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IMPORTANT SAFETY INFORMATION 

INDICATION

CONTRAINDICATIONS

  • SYFOVRE is contraindicated in patients with ocular or periocular infections, in patients with active intraocular inflammation, and in patients with hypersensitivity to pegcetacoplan or any of the excipients in SYFOVRE. Systemic hypersensitivity reactions (e.g., anaphylaxis, rash, urticaria) have occurred.

SYFOVRE® (pegcetacoplan injection) is indicated for the treatment of geographic atrophy (GA) secondary to age-related macular degeneration (AMD).

WARNINGS AND PRECAUTIONS

  • Endophthalmitis and Retinal Detachments

    • Intravitreal injections, including those with SYFOVRE, may be associated with endophthalmitis and retinal detachments. Proper aseptic injection technique must always be used when administering SYFOVRE to minimize the risk of endophthalmitis. Patients should be instructed to report any symptoms suggestive of endophthalmitis or retinal detachment without delay and should be managed appropriately.

  • Retinal Vasculitis and/or Retinal Vascular Occlusion

    • Retinal vasculitis and/or retinal vascular occlusion, typically in the presence of intraocular inflammation, have been reported with the use of SYFOVRE. Cases may occur with the first dose of SYFOVRE and may result in severe vision loss. Discontinue treatment with SYFOVRE in patients who develop these events. Patients should be instructed to report any change in vision without delay.

  • Neovascular AMD

    • In clinical trials, use of SYFOVRE was associated with increased rates of neovascular (wet) AMD or choroidal neovascularization (12% when administered monthly, 7% when administered every other month and 3% in the control group) by Month 24. Patients receiving SYFOVRE should be monitored for signs of neovascular AMD. In case anti-Vascular Endothelial Growth Factor (anti-VEGF) is required, it should be given separately from SYFOVRE administration.

  • Intraocular Inflammation

    • In clinical trials, use of SYFOVRE was associated with episodes of intraocular inflammation including: vitritis, vitreal cells, iridocyclitis, uveitis, anterior chamber cells, iritis, and anterior chamber flare. After inflammation resolves, patients may resume treatment with SYFOVRE.

  • Increased Intraocular Pressure

    • Acute increase in IOP may occur within minutes of any intravitreal injection, including with SYFOVRE. Perfusion of the optic nerve head should be monitored following the injection and managed as needed.

ADVERSE REACTIONS

  • Most common adverse reactions (incidence ≥5%) are ocular discomfort, neovascular age-related macular degeneration, vitreous floaters, conjunctival hemorrhage.

INDICATION

SYFOVRE® (pegcetacoplan injection) is indicated for the treatment of geographic atrophy (GA) secondary to age-related macular degeneration (AMD).

Please see full Prescribing Information for more information