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    v1.0.28
    OpenPayerBilling CodesDrugs Administered Other than Oral MethodHCPCS hcpcs-j1095-intraocular-dexamethasone-9pct-1mcg-injection
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    HCPCS Level II J1095: Intraocular Dexamethasone Injection 1 μg

    HCPCS Level II code J1095 represents an intraocular injection of dexamethasone 9 percent formulated for ophthalmic use with a unit of service of 1 microgram; the service is an intravitreal/intraocular corticosteroid injection intended for ophthalmic inflammatory or edema indications and is typically performed in an ambulatory surgery center, office-based ophthalmology clinic, or hospital outpatient department.

    For related coverage guidance, see recent payer policy updates: Epithelial Cell Cytology in Breast Cancer Risk Assessment, Chemotherapy Observation or Inpatient Hospitalization (for New Mexico Only), Umbilical Cord Blood Harvesting and Storage for Future Use (for Indiana Only).

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    Clinical & Coding Specifications

    Clinical Context

    A 68-year-old patient with a history of diabetic macular edema presents to a retinal specialist for intravitreal therapy. After ophthalmic examination and optical coherence tomography confirming persistent central macular thickening, the provider selects an intraocular corticosteroid formulation of dexamethasone to reduce inflammation and macular edema. The patient is prepped in a procedure room or ambulatory surgical center; topical anesthesia and antisepsis with povidone-iodine are applied. The clinician performs an intravitreal injection of J1095 (injection, dexamethasone 9 percent, intraocular, 1 microgram) into the vitreous cavity using sterile technique. Post-injection, the patient is observed for intraocular pressure elevation and endophthalmitis signs for a brief monitoring period, instructed on post-procedure precautions, and scheduled for follow-up intraocular pressure checks and retinal imaging to assess treatment response and plan further injections if indicated.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    67028Intravitreal injection of a therapeutic agentDirect procedural CPT code commonly billed for the injection administration component performed alongside billing for the drug HCPCS code J1095 when applicable.
    67036Vitrectomy, pars plana; 1 or more stages, with removal of vitreousPerformed when vitreoretinal surgery is required for complications or underlying disease not controlled by intravitreal injections.
    92083Visual field examination, extendedUsed for functional assessment in retinal disease management and monitoring response to therapy.
    92134Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report (OCT)Performed before or after injection to quantify macular edema and monitor therapeutic response.
    99214Office or other outpatient visit for the evaluation and management of an established patient, moderate complexityUsed for pre-procedure evaluation or post-injection follow-up visits documenting response, complications, and ongoing management.

    Related Modifiers

    8 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
    82Modifier 82 is appended to a surgical CPT code to indicate that an attending physician acted as an assistant because a qualified resident surgeon was unavailable. In teaching hospitals it documents…- When to use: Append modifier 82 in teaching-hospital settings to indicate a physician served as an assistant surgeon because a qualified resident surgeon was unavailable (includes situations where…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    207W00000XOphthalmology PhysicianAn ophthalmologist has the knowledge and professional skills needed to provide comprehensive eye and vision care. Ophthalmologists are medically train…
    364S00000XClinical Nurse SpecialistA registered nurse who, through a graduate degree program in nursing, or through a formal post-basic education program or continuing education courses…
    208D00000XGeneral Practice PhysicianA physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.
    363L00000XNurse Practitioner(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision mak…
    207SC0300XClinical Cytogenetics PhysicianA clinical cytogeneticist demonstrates competence in providing laboratory diagnostic and clinical interpretive services dealing with cellular componen…
    156FX1202XOptometric TechnicianAn optometric technician assists optometrists by performing duties, including but not limited to, basic eye testing, diagnostic tests, and assistance …
    343900000XNon-emergency Medical Transport (VAN)A land vehicle with a capacity to meet special height, clearance, access, and seating, for the conveyance of persons in non-emergency situations. The …
    251J00000XNursing Care AgencyA Nursing Care Agency is an entity that provides skilled nursing care through the services of a Registered Nurse (RN) or a Licensed Practical Nurse (L…

    Related ICD-10-CM Codes

    18 rows

    ICD-10-CM CodeDescription
    H25.13Age-related nuclear cataract, bilateral
    H26.9Unspecified cataract
    H35.031Hypertensive retinopathy, right eye
    H35.033Hypertensive retinopathy, bilateral
    H35.039Hypertensive retinopathy, unspecified eye
    H35.052Retinal neovascularization, unspecified, left eye
    H35.062Retinal vasculitis, left eye
    H35.351Cystoid macular degeneration, right eye
    H35.352Cystoid macular degeneration, left eye
    H35.353Cystoid macular degeneration, bilateral

    Showing 1–10 of 18

    Related Payer Policy Updates

    Specialty: Hematology/Oncology1 / 3

    10 rows

    PolicyPayerEffective Date
    Epithelial Cell Cytology in Breast Cancer Risk AssessmentOscar Health2026-10-01
    Chemotherapy Observation or Inpatient Hospitalization (for New Mexico Only)UnitedHealthcare2026-08-01
    Umbilical Cord Blood Harvesting and Storage for Future Use (for Indiana Only)UnitedHealthcare2026-08-01
    Antibody-Drug ConjugatesPremera Bluecross2026-08-01
    Chimeric Antigen Receptor (CAR) T-Cell TherapyColorado Rocky Mountain Health Plans2026-08-01
    Allogeneic Hematopoietic Progenitor Cell TherapyAmbetter Georgia2026-08-01
    Umbilical Cord Blood Harvesting and Storage for Future Use (for Idaho Only)UnitedHealthcare2026-08-01
    Umbilical Cord Blood Harvesting and Storage for Future Use (for New Jersey Only)UnitedHealthcare2026-08-01
    Umbilical Cord Blood Harvesting and Storage for Future Use (for Ohio Only)UnitedHealthcare2026-08-01
    Reblozyl (luspatercept-aamt) Medical Benefit Drug PolicyUnitedHealthcare2026-08-01

    Related Codes

    HCPCS-J0013-ESKETAMINE-NASAL-SPRAY-1MG

    HCPCS Level II J0013: Esketamine Nasal Spray, 1 mg

    HCPCS-J0120-INJECTION-TETRACYCLINE-250MG

    HCPCS Level II J0120: Injection, Tetracycline, up to 250 mg

    HCPCS-J0121-OMADACYCLINE-INJECTION-1MG

    HCPCS Level II J0121: Omadacycline Injection, 1 mg

    HCPCS-J0122-ERAVACYCLINE-INJECTION-1MG

    HCPCS Level II J0122: Injection, eravacycline, 1 mg

    HCPCS-J0129-ABATACEPT-INJECTION-10MG-PHYSICIAN-SUPERVISED

    HCPCS Level II J0129: Abatacept Injection, 10 mg

    HCPCS-J0130-INJECTION-ABCIXIMAB-10MG

    HCPCS Level II J0130: Injection abciximab, 10 mg

    HCPCS-J0131-INJECTION-ACETAMINOPHEN-10MG-PARENTERAL-ANALGESIC

    HCPCS Level II J0131: Injection, Acetaminophen 10 mg

    HCPCS-J0132-INJECTION-ACETYLCYSTEINE-100MG-INJECTABLE-MEDICATION

    HCPCS Level II J0132: Injection, Acetylcysteine 100 mg

    HCPCS-J0133-ACYCLOVIR-INJECTION-5MG

    HCPCS Level II J0133: Injection, Acyclovir 5 mg

    HCPCS-J0134-ACETAMINOPHEN-INJECTION-FRESENIUS-KABI-10MG

    HCPCS Level II J0134: Injection, Acetaminophen (10 mg)

    Showing 1–10 of 991

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    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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