Ocular Therapeutix announced that the Centers for Medicare and Medicaid Services (CMS) has issued a permanent product-specific J-code for Dextenza (dexamethasone ophthalmic insert) 0.4mg for intracanalicular use. Under the Healthcare Common Procedure Coding System (HCPCS), the J-code (J1096) will become effective October 1, 2019 and will replace the previously issued C-code for Dextenza (C9048), which became effective July 1, 2019. The company will retain transitional pass-through status granted for Dextenza from CMS.
“We are pleased that Dextenza has received its own permanent product-specific J-Code,” Antony Mattessich, President and Chief Executive Officer, said in a company news release. “Dextenza, unlike most products with pass-through payment status, may be deployed intraoperatively, but may over time also be utilized in the office setting. We have had a significant number of physicians who have expressed interest in using Dextenza in the office setting so their patients can enjoy the benefits of local programmed release treatment while the surgeon’s time in surgery is fully optimized. J-Codes are more widely recognized by commercial insurance and Medicare Advantage and Part B plans, and physician familiarity with J-codes should allow for a simpler and more convenient reimbursement process that we believe will further contribute to Dextenza’s commercial potential.”