Email content sponsored by Apellis Pharmaceuticals, Inc.
Email content sponsored by Apellis Pharmaceuticals, Inc.
Effective for claims on and after October 1, 2023:
J2781
SYFOVRE (pegcetacoplan injection) is indicated for the treatment of geographic atrophy (GA) secondary to age-related macular degeneration (AMD)
SELECT SAFETY INFORMATION
SYFOVRE is contraindicated in patients with ocular or periocular infections, and in patients with active intraocular inflammation.
Please see additional Important Safety Information below.
PRODUCT SPECIFICATIONS1:
Permanent J-Code
J2781, effective October 1, 2023
CMS Long Descriptor2
Injection, pegcetacoplan, intravitreal, 1 mg*
*Dose descriptor is assigned by CMS; please see full prescribing information for approved dosing
NDC Number
10-digit: 73606-020-01 and 11-digit: 73606-0020-01
CPT Code3
67028: Intravitreal injection of a pharmacologic agent, separate procedure
Geographic Atrophy ICD-10-CM Diagnosis Codes4
Non-exudative age-related macular degeneration
Right Eye
Left Eye
Bilateral
Advanced atrophic without subfoveal involvement
H35.3113
H35.3123
H35.3133
Advanced atrophic with subfoveal involvement
H35.3114
H35.3124
H35.3134
This coding information is provided for informational purposes only, may be subject to change, and in no way should be considered a guarantee of coverage or reimbursement for any product or service.
INDICATION
SYFOVRE® (pegcetacoplan injection) is indicated for the treatment of geographic atrophy (GA) secondary to age-related macular degeneration (AMD).
IMPORTANT SAFETY INFORMATION
CONTRAINDICATIONS
SYFOVRE is contraindicated in patients with ocular or periocular infections, and in patients with active intraocular inflammation
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.
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.
