January 25, 2022
Triamcinolone Acetonide Injectable Suspension, for Suprachoroidal Use (Xipere™) Billing and Coding Instructions
Xipere™ is FDA approved corticosteroid injection for the treatment of macular edema associated with uveitis. Xipere is available in a single use suprachoroidal microinjector.
Coding for Xipere™
HCPCS:
There is not a specific code for this drug, so it is expected to be billed with:
- Part B: Use HCPCS J3490 (Unclassified drug)
- Part A: Use HCPCS C9399 (Unclassified drug or biological)
Include name of the drug, national drug code (NDC) number, and the exact dosage administered
- Electronic claims - Loop 2300, NTE Segment (header level) or Loop/Element 2400 SV101-7, NTE Segment (line level)
- Paper Claims - Item 19 of CMS-1500 form or Form Locator 80 on the UB-04 Form
CPT:
The injection procedure is billed with CPT code 0465T
ICD-10 associate with ICD-10 code aligned with FDA labeled use for this product such as:
The claim must be with both the ICD-10 code for uveitis AND macular edema
Non-infectious Uvetitis
- Anterior uveitis
- Primary iridocyclitis (H20.011, H20.012, H20.013)
- Recurrent acute iridocyclitis (H20.021, H20.022, H20.023)
- Intermediate uveitis (H30.21, H30.22, H30.23)
- Panuveitis (H44.111, H44.112, H44.113)
- Posterior uveitis
- Exudative retinopathy (H35.021, H35.022, H35.023)
- Retinal vasculitis (H35.061, H35.062, H35.063)
- Focal chorioretinal inflammation, juxtapapillary (H30.011, H30.012, H30.013)
- Focal chorioretinal inflammation of posterior pole (H30.021, H30.022, H30.023)
- Focal chorioretinal inflammation, peripheral (H30.031, H30.032, H30.033)
- Focal chorioretinal inflammation, macular or paramacular (H30.041, H30.042, H30.043)
- Disseminated chorioretinal inflammation posterior pole (H30.111, H30.112, H30.113)
- Disseminated chorioretinal inflammation, peripheral (H30.121, H30.122, H30.123)
- Disseminated chorioretinal inflammation, generalized (H30.131, H30.132, H30.133)
- Other chorioretinal inflammations (H30.891, H30.892, H30.893)
- Harada’s disease (H30.811, H30.812, H30.813)
- Vogt-Koyanagi Syndrome (H20.821, H20.822, H20.823)
Macular Edema
- Cystoid macular degeneration (H35.351, H35.352, H35.353)
- Retinal edema (H35.81)
NOTE: Unlabeled use of drug is subject to review on case-to-case basis and will require to meet reasonable and necessary criteria for off-label use as described in Medicare Benefit Policy Manual Chapter 15,Section 50.4.2, Unlabeled Use of Drug.