Ocular Therapeutix announced that the Centers for Medicare and Medicaid Services (CMS) has assigned a specific and permanent reimbursement J-code through the Healthcare Common Procedure Coding System (HCPCS) for Dextenza (dexamethasone ophthalmic insert) 0.4 mg, which is approved for the treatment of ocular inflammation and pain following ophthalmic surgery. The code assigned to Dextenza, J1096, will become effective on October 1, 2019.
“We are pleased that CMS has issued a unique J-code for Dextenza, and has done so one full quarter earlier than expected,” Antony Mattessich, President and Chief Executive Officer, said in a company news release. “Issuance of the J-code is important for the company as it now enables reimbursement in the office setting as well as in the surgical center, providing increased flexibility to physicians on how they use the product. We anticipate that having a J-code assigned will facilitate reimbursement of and increase access to our product and will give us the opportunity to expand the target market of Dextenza to commercial insurers.”
A J-Code is a permanent reimbursement code established by CMS for the Prospective Payment System used to report drugs that ordinarily cannot be self-administered. J-codes are familiar to both medical practices and their billing staffs, as well as Medicare (Part B and Part C) and commercial insurers. As a result, J-codes allow for a simpler and more convenient reimbursement process.