Ocular Therapeutix announced that the Centers for Medicare and Medicaid Services (CMS) has approved transitional pass-through payment status and established a new reimbursement code for Dextenza (dexamethasone ophthalmic insert). The code, C9048, is scheduled to become effective July 1, 2019.
“We are pleased to receive pass-through payment status and assignment of a new C-code for Dextenza, which physicians and their practices may use for reimbursement of the product,” Antony Mattessich, President and Chief Executive Officer, said in a company news release. “With sample product available and insertion training sessions already underway, the receipt of the C-code is another important step in the commercial launch of Dextenza.”
A C-code is a unique temporary product code established by CMS for the Hospital Outpatient Prospective Payment System (OPPS) used to report claims for hospital outpatient department and ambulatory surgical center services and procedures. The formal receipt of the C-code facilitates the reimbursement of Dextenza until such time as CMS may potentially approve a J-code and such approval becomes effective. In May 2019, the company announced that CMS has included Dextenza on its list of products that have been preliminarily recommended for a new dedicated Healthcare Common Procedure Coding System (HCPCS) J-code which, if granted, would become effective January 1, 2020. A J-code represents a permanent product code that could be used across settings of care.