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
FFF Enterprises 1-800-843-7477 1-800-418-4333 www.fffenterprises.com
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

Phone: 1-800-543-2111

Fax: 1-800-543-8695

Website: www.besse.com

Cardinal Speciality Pharma Distribution

Phone: 1-855-5855-0708

Fax: 1-614-553-6301

Website: inhealth.com/specialityonline

FFF Enterprises

Phone: 1-800-843-7477

Fax: 1-800-418-4333

Website: www.fffenterprises.com

Metro Medical

Phone: 1-800-768-2002

Fax: 1-615-256-4194

Website: www.metromedicalorder.com

McKesson Medical-Surgical

Phone: 1-855-571-2100

Fax: 1-800-311-3408

Website: mms.mckensson.com

McKesson Plasma & Biologics for Hospitals

Phone: 1-877-625-2566

Fax: 1-888-752-7626

Website: connect.mckensson.com

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
PRODUCTS

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 opthalmic insert, 0.1 mg

Product Code Description
J1096
J-code*
Dexamethasone, lacrimal ophthalmic insert, 0.1mg

As of January 1, 2023, DEXTENZA® will receive separate payment in the ASC setting due to meeting the criteria for non-opioid pain management drugs and biologicals that function as surgical supplies. DEXTENZA’s pass-through status expired on December 31, 2022.

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 H101 H1011 H1012 H1013 H1010
Unspecified acute conjunctivitis H103 H1031 H1032 H1033 H1030
Chronic conjunctivitis H104 H10401 H10402 H10403 H10409
Chronic giant papillary conjunctivitis H1041 H10411 H10412 H10413 H10419
Vernal conjunctivitis H1044

An ICD-10 code, when billing for ocular itching associated with allergic conjunctivitis, will be required.

Other chronic allergic conjunctivitis H1045
Other conjunctivitis H1089
Unspecified conjunctivitis H109
Conjunctivitis H10
Unspecified chronic conjunctivitis H1040

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 Allergic Conjuctivitis.

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.

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).

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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.