Lucentis received higher average payment on professional claims compared to Outpatient Institutional claims from Medicare


In Lucentis

By: Avinash Kumar  May. 09, 2019

Lucentis is a trade name of Ranibizumab indicated for the treatment of conditions such as Wet Age-related Macular Degeneration (wAMD), Diabetic Retinopathy (DR), Diabetic Macular Edema (DME), Myopic Choroidal Neovascularization (mCNV) and Macular Edema following Retinal Vein Occlusion (RVO). Other drugs used for treating Wet Age-related Macular Degeneration (wAMD) are Avastin and Eylea.

The top two retinal diseases that affect a large proportion of the Medicare population are age-related macular degeneration (AMD) and diabetic retinopathy and both diseases limit patients’ sight.

Healthcare professionals use HCPCS code J2778 - Injection, Ranibizumab, 0.1 MG to get reimbursement from the payers. Dexur analysed Medicare claims data (Jul 2017 to Jun 2018) with regards to avg.payout of Lucentis from Medicare for both professional claims and Outpatient Institutional claims.

Lucentis received an average payment of $1,534 on professional claims whereas the Outpatient institutional claims received $1,418 as an average payment from Medicare.

Dexur also has a more in depth database of patients who have Wet Age-related Macular Degeneration (wAMD), Diabetic Retinopathy (DR), Diabetic Macular Edema (DME), Myopic Choroidal Neovascularization (mCNV) and Macular Edema following Retinal Vein Occlusion (RVO) and can benefit from the usage of Lucentis.

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ABOUT THE AUTHOR

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Avinash Kumar

Avinash Kumar is a Business analyst with over 9 years of healthcare experience. He has expertise in Real World Evidence (RWE), healthcare claims analytics, market research, data analytics, benefits configuration, claim contractual reprising, adjudication, implementation of reimbursement rule edits for healthcare payers and revenue cycle management for providers. Avinash holds a Master's degree in Operations management and life sciences. He is a certified medical coder from American Association of Professional Coders (AAPC).