Billing and Coding: FDA approves Iluvien for Diabetic Macular Edema

ILUVIEN (fluocinolone acetonide 0.19 mg intravitreal implant, HCPCS J7313) is FDA-approved and covered for treatment of diabetic macular edema in patients who previously received a course of corticosteroids without a clinically significant rise in intraocular pressure. Claims must include HCPCS J7313, the total dosage 0.19 mg in the narrative field, and an appropriate ICD-10 diagnosis for DME; medical records should document prior steroid treatment and IOP response. The implant is designed to release medication continuously for up to 36 months after a single injection; repeat administration frequency is not specified in this policy.

"Treatment of diabetic macular edema (DME)."

Sign up to see full coverage criteria, indications, and limitations.