Ocular Therapeutix Announces Receipt of a Permanent Category I CPT Code From the AMA for the Insertion of Intracanalicular Inserts

Ocular Therapeutix announced that its application for the creation of a Category I Current Procedural Terminology (CPT) procedure code, presented at the October 2020 American Medical Association (AMA) CPT Editorial Panel meeting, has been granted. The Panel has accepted the addition of a permanent Category I CPT procedure code to replace the currently available Category III CPT code (0356T) for the administration of drug-eluting intracanalicular inserts, including Dextenza (dexamethasone ophthalmic insert) 0.4 mg, effective January 1, 2022.

Compelling clinical evidence, widespread utilization, and physician society support are required in obtaining a permanent CPT code. Category I codes normally have a standardized Medicare physician fee schedule, and as a result are anticipated to improve coverage and payment across all payers for procedures performed in both the ASC and physician office settings.

“This is an important milestone towards establishing an appropriate coding and reimbursement environment for our intracanalicular products and in realizing our goal of replacing eye drops for certain conditions,” Antony Mattessich, President and Chief Executive Officer of Ocular Therapeutix, said in a company news release. “The recognition by the AMA that a separate code should be available for the placement of these inserts affirms this novel route of administration. We believe Category I status for the procedure of inserting a drug eluting insert into the lacrimal canaliculus delivers immediate benefits for not only Dextenza, but also for the other product candidates in our pipeline portfolio that are designed to utilize the same route of administration, including our two programs in dry eye disease.”

Prior to the January 1, 2022 effective date of the newly issued Category I CPT code, payments to physicians are expected to continue with the service reported using CPT code 0356T.