Effective June 18, 2009, the FDA granted approval for Ozurdex, a 0.7 mg intravitreal implant for the treatment of macular edema following branch retinal vein occlusion (BRVO) and central retinal vein occlusion (CRVO).
According to the package insert, effectiveness is based on less than 15 letter best-corrected visual acuity (BCVA) improvement. This improvement occurs within the first two months after implantation and the effects last one to three months after the onset of the improvement. Therefore, Palmetto GBA would not expect to see a frequency of more than once a quarter. Patients without a documented response would not benefit for repeat implants.
To bill for Ozurdex™ services, submit the following codes:
- CPT code 67028 - Intravitreal injection of a pharmacologic agent (separate procedure) system
- HCPCS code J3490 – unclassified drugs for the Ozurdex implant
- QB field should be 1 unit
- Enter the following information in the comment/narrative note field:
- NDC number
- Ozurdex
- Until Palmetto GBA receives enough claims to determine a price, providers must submit an invoice copy for this drug