Revised 1/5/2024

Question: How do we bill for Dextenza when used with cataract surgery?

Answer: Dextenza is a corticosteroid that is used to treat inflammation following ophthalmic surgery. The HCPCS code is J1096 Dexamethasone, lacrimal ophthalmic insert, 0.1 mg, became effective October 1, 2019, and should be billed with 4 units. It currently has a pass-through status in the ambulatory surgical center (ASC) setting The ASC would bill  the HCPCS code J1096 and the physician would bill the procedure code 68841 Insertion of drug-eluting implant, including punctal dilation when performed, into lacrimal canaliculus, each. Coverage may vary by payer. For any single-dose containers, vials and packages based on Food and Drug Administration (FDA)-approved labeling with discarded drugs less than 1 unit, append modifier JZ to the HCPCS code reported.