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Avastin® (Bevacizumab) – Medicare Advantage Policy Guideline

Avastin (Bevacizumab) Page 1 of 25 UnitedHealthcare Medicare Advantage Policy Guideline Approved 07/14/2021 Proprietary Information of UnitedHealthcare. Copyright 2021 United HealthCare Services, Inc. UnitedHealthcare Medicare Advantage Policy Guideline Avastin (Bevacizumab) Guideline Number: Approval Date: July 14, 2021 Terms and Conditions Table of Contents Page Policy Summary .. 1 Applicable Codes .. 4 Definitions .. 21 References .. 22 Guideline History/Revision Information .. 23 Purpose .. 24 Terms and Conditions .. 25 Policy Summary See Purpose Overview Bevacizumab is a monoclonal antibody produced by recombinant DNA technology in Chinese hamster ovaries.

The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed. Coding Guidelines Diagnosis codes must be listed to the most specific number Use the appropriate HCPCS code to report the drug being used . Ophthalmology Avastin ®

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