Intravitreal injection of ranibizumab, bevacizumab, or aflibercept may be considered medically necessary for the treatment of the following retinal vascular conditions:
Diabetic macular edema*
Diabetic retinopathy*
Macular edema following retinal vein occlusion*
Retinopathy of prematurity
Neovascular glaucoma
Rubeosis (neovascularization of the iris)
Intravitreal injection of ranibizumab, bevacizumab, or aflibercept is considered investigational for the treatment of all other retinal vascular disorders. Intravitreal injection of pegaptanib is considered investigational for treatment of retinal vascular disorders, including proliferative diabetic retinopathy, diabetic macular edema, and central or branch retinal vein occlusion. * FDA approved indication (Lucentis and EYLEA)
