Ocular Therapeutix Announces Its First Published Physician Fee Schedule for Administration of Intracanalicular Inserts

Ocular Therapeutix announced that Novitas Solutions, one of seven Medicare Administrative Contractors (MACs), became the first MAC to establish a physician fee schedule for procedure code 0356T for the administration of drug-eluting intracanalicular inserts, including Dextenza (dexamethasone ophthalmic insert) 0.4mg, effective July 1, 2020. The professional fee for CPT code 0356T is now eligible to be paid per the established local fee schedule, which can be found on the Novitas website.

“We are pleased to see that physicians may now seek professional fee reimbursement for the administration of Dextenza and anticipate this determination could accelerate product adoption,” Antony Mattessich, President and Chief Executive Officer of Ocular Therapeutix, said in a company news release. “This is a positive development not only for Dextenza, but also for the other product candidates in our pipeline portfolio that utilize the same route of administration.”

Novitas covers Medicare patients in 10 states, including New Mexico, Texas, Colorado, Oklahoma, Arkansas, Louisiana, Mississippi, New Jersey, Pennsylvania, Delaware, and the District of Columbia.