RESOLVED: Denial of Intravitreal Injections Exceeding Frequency Limitation

Published 03/25/2025

RESOLVED: Denial of Intravitreal Injections Exceeding Frequency Limitation
Current Status Date  
Resolved March 24, 2025  Status: Adjustments have been completed.
Open March 11, 2025 Status: Claims have been identified, and adjustments are being initiated.
Provider Action: There is no provider action at this time. 
Issue Description
A system edit has been in place for many years enforcing intravitreal injection frequencies based on the relevant Food and Drug Administration labels, with a generous buffer to allow for scheduling conflicts. J2781 was included in a recent update to the edit, but after reconsideration, the Centers for Medicare & Medicaid Services is removing this J code from the edit and allowing Medicare Administrative Contractors to reprocess the claims. 

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