Ordering and Reimbursement
PURCHASE OPTIONS
Contact one of our authorized distributors listed below to order DEXTENZA and receive it by the next business day.
| Distributor | Phone | Fax | Website |
|---|---|---|---|
| Besse Medical | 1-800-543-2111 | 1-800-543-8695 | www.besse.com |
| Cardinal Specialty Pharma Distribution |
1-855-855-0708 | 1-614-553-6301 | www.cardinalhealth.com/specialtyonline |
| Metro Medical | 1-800-768-2002 | 1-615-256-4194 | www.metromedicalorder.com |
| McKesson Medical-Surgical |
1-855-571-2100 | 1-800-311-3408 | mms.mckesson.com |
| McKesson Plasma & Biologics for Hospitals |
1-877-625-2566 | 1-888-752-7626 | connect.mckesson.com |
DISTRIBUTORS
Besse Medical
Cardinal Speciality Pharma Distribution
Metro Medical
McKesson Medical-Surgical
McKesson Plasma & Biologics for Hospitals
Ocular Therapeutix does not recommend the use of any particular distributor.
| Product | Active Ingredient | Size | 10-Digit NDC* | 11-Digit NDC† |
|---|---|---|---|---|
| DEXTENZA (dexamethasone ophthalmic insert) 0.4mg |
(dexamethasone USP) | 1 | 70382-204-01 | 70382-0204-01 |
| DEXTENZA (dexamethasone ophthalmic insert) 0.4mg |
(dexamethasone USP) | 10 | 70382-204-10 | 70382-0204-10 |
DEXTENZA (dexamethasone opthalmic insert) 0.4mg
Active Ingredient (dexamethasone USP)
Size 1’s
10 Digit NDC # 70382-204-01
11 Digit NDC # 70382-0204-01
DEXTENZA (dexamethasone opthalmic insert) 0.4mg
Active Ingredient (dexamethasone USP)
Size 10’s
10 Digit NDC # 70382-204-10
11 Digit NDC # 70382-0204-10
*10 Digit NDC code as assigned by FDA, certain payers accept the 10 digit format
†11 Digit NDC code that can be utilized for payers that require 11 digits or when ordering product
For further purchase inquiries, please contact your distributor or Ocular Therapeutix, Inc.
Customer Service: 1-888-315-7906
Monday – Friday 9:00AM - 7:00PM EST
Billing and Coding
Product Reimbursement
PRODUCT CODE
J1096
J-Code*
Description
Dexamethasone, lacrimal ophthalmic insert, 0.1 mg†
| Product Code | Description |
|---|---|
| J1096 J-code* |
Dexamethasone, lacrimal ophthalmic insert, 0.1mg† |
As of January 1, 2023, DEXTENZA has separate payment in the ASC‡ setting due to meeting the criteria set forth in the non-opioid as a surgical supply provision by CMS.
Procedure Reimbursement
PROCEDURE CODE
68841
CPT§ code
Description
Insertion of drug-eluting implant (including punctual dilation and implant removal when performed into lacrimal canaliculus, each)
| Procedure Code | Description |
|---|---|
| 68841 CPT code§ |
Insertion of drug-eluting implant (including punctal dilation and implant removal when performed into lacrimal canaliculus, each) |
ICD||-10 Codes Associated with Ophthalmic Surgery
ICD*-10 Codes† Associated with Ophthalmic Surgery
Multiple Codes for Ophthalmic Surgery
Description
ICD*-10 Codes† Associated with Ophthalmic Surgery are best viewed via desktop or tablet.
| Ophthalmic Surgery | General | Right Eye | Left Eye | Bilateral | Unspecified Eye |
|---|---|---|---|---|---|
| Ocular pain | H57.1 | H57.11 | H57.12 | H57.13 | H57.10 |
| Cataract extraction status | Z98.4 | Z98.41 | Z98.42 | – | Z98.49 |
| Presence of intraocular lens; presence of pseudophakia |
Z96.1 | – | – | – | – |
| Cortical age related cataract | H25.01 | H25.011 | H25.012 | H25.013 | H25.019 |
| Other acute post-procedural pain | G89.18 | – | – | – | – |
ICD-10 Codes Associated with Allergic Conjunctivitis
| Allergic Conjunctivitis | General | Right Eye | Left Eye | Bilateral | Unspecified Eye |
|---|---|---|---|---|---|
| Acute atopic conjunctivitis | H10.1 | H10.11 | H10.12 | H10.13 | H10.10 |
| Unspecified acute conjunctivitis | H10.3 | H10.31 | H10.32 | H10.33 | H10.30 |
| Chronic conjunctivitis | H10.4 | H10.401 | H10.402 | H10.403 | H10.409 |
| Chronic giant papillary conjunctivitis | H10.41 | H10.411 | H10.412 | H10.413 | H10.419 |
| Vernal conjunctivitis | H10.44 |
This may not be a complete list of ICD-10 codes, click here for a list of all codes. |
|||
| Other chronic allergic conjunctivitis | H10.45 | ||||
| Other conjunctivitis | H10.89 | ||||
| Unspecified conjunctivitis | H10.9 | ||||
| Conjunctivitis | H10 | ||||
| Unspecified chronic conjunctivitis | H10.40 | ||||
Customers are responsible for determining the appropriate coding and submission of accurate claims.
This may not be a complete list of codes.
Visit https://www.cms.gov/Medicare/Coding/ICD10/ICD-10Resources for a complete list of ICD-10 codes associated with Ophthalmic Surgery and Allergic Conjunctivitis.
DEXTENZA360™ provides comprehensive support for obtaining benefits identification.
Coverage and reimbursement may vary by payer, contractual agreements, and site of service. Customers are responsible for determining the appropriate coding and submission of accurate claims. Ocular Therapeutix does not guarantee reimbursement or payment of claims.
*A permanent code used to report non-orally administered drugs that cannot be self-administered. May be accompanied by a procedure-based CPT code.
†When submitting a claim, enter a unit of 4 for the DEXTENZA HCPCS code(J1096). The HCPCS descriptor for DEXTENZA is 0.1mg.
‡Medicare Advantage (Part C) and Commercial plans may or may not follow Medicare recommendations in making coverage decisions. Payment rates may vary per facility contracts.
§CPT® is a registered trademark of the American Medical Association. Current Procedural Terminology (CPT®), an alphanumeric coding system maintained by the American Medical Association to identify medical services and procedures provided by physicians and other healthcare professionals.
||International Classifications of Diseases (ICD).
IMPORTANT SAFETY INFORMATION
CONTRAINDICATIONS
DEXTENZA is contraindicated in patients with active corneal, conjunctival or canalicular infections, including epithelial herpes simplex keratitis (dendritic keratitis), vaccinia, varicella; mycobacterial infections; fungal diseases of the eye, and dacryocystitis.
WARNINGS AND PRECAUTIONS
Intraocular Pressure Increase – Prolonged use of corticosteroids may result in glaucoma with damage to the optic nerve, defects in visual acuity and fields of vision. Steroids should be used with caution in the presence of glaucoma. Intraocular pressure should be monitored during treatment.
Bacterial Infections – Corticosteroids may suppress the host response and thus increase the hazard for secondary ocular infections. In acute purulent conditions, steroids may mask infection and enhance existing infection.
Viral Infections – Use of ocular steroids may prolong the course and may exacerbate the severity of many viral infections of the eye (including herpes simplex).
Fungal Infections – Fungus invasion must be considered in any persistent corneal ulceration where a steroid has been used or is in use. Fungal culture should be taken when appropriate.
Delayed Healing – Use of steroids after cataract surgery may delay healing and increase the incidence of bleb formation.
Other Potential Corticosteroid Complications – The initial prescription and renewal of medication order of DEXTENZA should be made by a physician only after examination of the patient with the aid of magnification, such as slit lamp biomicroscopy, and, where appropriate, fluorescein staining. If signs and symptoms fail to improve after 2 days, the patient should be re-evaluated.
ADVERSE REACTIONS
Ocular Inflammation and Pain Following Ophthalmic Surgery
The most common ocular adverse reactions that occurred in patients treated with DEXTENZA were: anterior chamber inflammation including iritis and iridocyclitis (10%), intraocular pressure increased (6%), visual acuity reduced (2%), cystoid macular edema (1%), corneal edema (1%), eye pain (1%), and conjunctival hyperemia (1%). The most common non-ocular adverse reaction was headache (1%).
Itching Associated with Allergic Conjunctivitis
The most common ocular adverse reactions that occurred in patients treated with DEXTENZA were: intraocular pressure increased (3%), lacrimation increased (1%), eye discharge (1%), and visual acuity reduced (1%). The most common non-ocular adverse reaction was headache (1%).
INDICATIONS
DEXTENZA is a corticosteroid indicated for:
- The treatment of ocular inflammation and pain following
ophthalmic surgery. - The treatment of ocular itching associated with allergic
conjunctivitis.
Please see full Prescribing Information.
24 Crosby Drive
Bedford, MA 01730
Phone: 1-877-628-8998
