< Billing codes

Billing code

E186A

Left eye macular degeneration injection

Bill for an intravitreal medication injection to treat wet macular degeneration in the left eye.

Watch for: Limit 12 per patient per 12 months unless exceptional circumstances are documented; not payable with E112 the same day.

Code

E186A

FHO+ basket

Not in the FHO+ base rate basket (Schedule 2 or 2B).

Effective date

Apr 1, 2026

Termination date

No end date

Explanation

Updated October 26, 2026

Intravitreal injection of medication to treat wet macular degeneration in the left eye. Up to 12 per patient per 12 months.

What it covers

Intravitreal injection of medication to treat wet (neovascular) macular degeneration in the left eye, listed under Vitreous – injections and/or paracentesis (Y6).

The fee is marked #: it does not include premises, equipment, supplies or staff for the procedure itself, which hospitals or facilities fund (SP1). No surgical assistant fee is payable (Y6).

Billing rules

• Limited to 12 per patient per 12 months. More is payable only in exceptional circumstances, with the clinical indications documented in the chart (Y6).
• The Schedule's commentary says most patients are controlled with about 8 injections a year; more than 8 should be supported by evidence of disease instability (Y7).
• Not payable with pneumatic retinopexy E112 on the same day (Y6, Y8).
• Z851 and Z844 paracentesis are not payable on the same day; bill the E175 add-on for therapeutic paracentesis instead, unless it is done through the same site (Y2, Y6).
• Anaesthesia by an anaesthetist is billed as E023C; GP97 time and extra units and E003C are not payable for these injections (Y6, GP100).
• Age premiums for surgical procedures apply to patients under 16 (GP64).

Often billed with

• E175 therapeutic paracentesis through a separate site (Y6).
• G821 or G822 OCT during active management with intravitreal injections (J93).

Common rejections

• AM1: Service limit exceeded: more than 12 injections in the left eye in 12 months without exceptional circumstances (Y6).
• ADH: Cannot be billed together: intravitreal injections are not payable with E112 pneumatic retinopexy on the same day (Y8).

Related codes: E187, E149, E175, G821, G822, G460, E112

Source: Schedule of Benefits (July 1, 2026), Ocular Surgical Procedures, Vitreous, page Y6.

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