Updated Jan. 3, 2024

Will you provide guidance on billing Xipere? Are other ophthalmic practices experiencing billing issues and/or denials?

Answer:
Report the procedure as Category III code 0465T. These types of codes are temporary codes for new and emerging technology. There are no relative value units (RVU) assigned, and many payers initially deny, and you will need to appeal. Prior authorization may be required for commercial or Medicare Advantage plans.

Code as: 
The procedure note should include dose and waste: 4 mg/0.1 mL was injected, and 32 mg/0.8 mL was wasted from the single-dose vial labeled as 0.9 mL (40mg/ml) of medication from one tray included in the Xipere carton.

Report NDC in 5-4-2 format in item 24a of the CMS-1500, 71565-0040-01 and unit of measurement (UOM) of ML0.9.

Note package description from the Food and Drug Administration National Drug Code (NDC) directory, which is consistent with labeling on medication vial.

1 tray in 1 carton (71565-040-01) > 1 vial in 1 tray > .9 ml in 1 vial

If possible, include the medication label in the procedure note.
Link both the macular edema and uveitis ICD-10-CM codes to the Category III and HCPCS codes. Review the retina and uveitis quick reference guides along with the anterior uveitis and panuveitis decision trees on our website aao.org/icd10.

Retina coding and billing guidance can be found at aao.org/retinapm.