J7313 — Injection, fluocinolone acetonide, intravitreal implant (iluvien), 0.01 mg
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- Submit HCPCS code J7313 (fluocinolone acetonide intravitreal implant, 0.19 mg) on Part B claims.
- Include total dosage '0.19 mg' in the narrative field of the claim.
- Include an appropriate ICD-10 diagnosis code for DME on the claim (policy references 'one of the ICD-10 diagnoses below').
- Maintain medical record documentation showing prior course of corticosteroid treatment for DME and documentation of IOP response (e.g., ophthalmology notes and IOP measurements).
Key Coverage Criteria
- Treatment of diabetic macular edema (DME).
- Patient has previously received a course of corticosteroid therapy for DME.
- No clinically significant rise in intraocular pressure (IOP) occurred during prior corticosteroid treatment.
- Ozurdex (dexamethasone intravitreal implant): Diabetic macular edema (DME).
- Retisert (fluocinolone acetonide intravitreal implant): Chronic non-infectious uveitis affecting the posterior segment of the eye.
- Yutiq (fluocinolone acetonide intravitreal implant): Chronic non-infectious uveitis affecting the posterior segment of the eye.
7 Active Policies
N/A — N/A
JJ Part B
PALMETTO-N/A — N/A
JJ Part B
UHC-POL-intravitreal-corticosteroid-implants — Intracanalicular and Intravitreal Corticosteroid Implants
AETNA-CPB-0719 — Fluocinolone Acetonide Intra-vitreal Implant (Retisert, Yutiq and Iluvien)
SUREST-POL-SUREST-intravitreal-corticosteroid-implants
Related Codes
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