Summary & Overview
HCPCS C9048: Dexamethasone Lacrimal Ophthalmic Insert, 0.1 mg
HCPCS Level II code C9048 denotes a dexamethasone lacrimal ophthalmic insert, 0.1 mg, a localized corticosteroid delivery device used for ocular inflammation. Nationally, a specific HCPCS code for this product matters because it standardizes billing, supports tracking utilization of implantable ophthalmic drug delivery, and guides coverage and reimbursement decisions for eye care procedures.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical use and site-of-service implications, payer coverage considerations, and where C9048 fits among related ophthalmic drug and device codes. The publication outlines benchmarks and policy-relevant context for payers and providers, including how a defined HCPCS Level II code can affect claims processing and benefit design.
The report provides clinical context for use of the lacrimal insert, typical outpatient settings for placement, and what to expect in claim submission when this code is used. It also highlights gaps where data was not provided and directs readers to sections that discuss related coding and coverage themes.
Billing Code Overview
HCPCS Level II code C9048 describes dexamethasone lacrimal ophthalmic insert, 0.1 mg. The code represents a topical corticosteroid delivered via an insert placed in the lacrimal system to provide localized anti-inflammatory therapy to the eye.
Service type: ophthalmic drug therapy via lacrimal implant
Typical site of service: ophthalmology clinic, ambulatory surgical center, or outpatient procedure area
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with postoperative inflammation following lacrimal duct or conjunctival surgery or an acute localized inflammatory condition of the lacrimal punctum/tear film requiring targeted corticosteroid delivery. The ophthalmologist assesses the patient in clinic, documents the indication (for example, postoperative inflammation or persistent localized conjunctival inflammation), and explains the lacrimal ophthalmic insert formulation. The provider prepares the sterile field, places topical anesthetic drops if needed, and inserts the C9048 dexamethasone lacrimal ophthalmic insert (0.1 mg) into the lacrimal punctum or canaliculus under magnification. The patient receives verbal and written aftercare instructions regarding symptoms to monitor, use of additional topical drops if prescribed, and follow-up timing. Follow-up visit or phone check is documented to evaluate clinical response and plan for removal if the insert is not bioresorbable. Typical site of service is an ophthalmology clinic, ambulatory surgical center, or office procedure room.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management (E/M) service by the same physician on the same day of the procedure | Use when a separate E/M visit is performed and documented on the same day as insertion of C9048. |