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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™


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


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 DrugExternal PDF.


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