Summary & Overview
HCPCS Level II J7355: Travoprost Intracameral Implant, 1 microgram
HCPCS Level II code J7355 identifies an intracameral implant formulation of travoprost billed per 1 microgram. This ophthalmic drug-delivery code is significant nationally as new sustained-release intraocular therapies expand options for glaucoma and ocular hypertension management, and payers update coverage and reimbursement for implantable ophthalmic pharmaceuticals. Key payers considered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will find a concise overview of the clinical context for an intracameral travoprost implant, typical sites of service, and the service type associated with J7355. The publication summarizes payer coverage patterns and benchmark comparisons, highlights coding and billing considerations relevant to hospital outpatient and ambulatory ophthalmology settings, and notes recent policy changes that affect reimbursement pathways. The content also outlines common modifiers and administrative elements used with this code when available and offers references to related code groups and clinical indications.
Data not available in the input for specific associated taxonomies, ICD-10 diagnoses, and detailed payer policy language is clearly noted where applicable.
Billing Code Overview
HCPCS Level II code J7355 represents an intracameral implant formulation of travoprost delivered as an injection, with a unit measure of 1 microgram. This code denotes a pharmacologic ophthalmic implant intended for intraocular administration.
Service Type: Injection — intracameral implant
Typical Site of Service: Ambulatory ophthalmology clinic or hospital outpatient setting, where intracameral injections and ophthalmic implant procedures are performed.
Clinical & Coding Specifications
Clinical Context
A 72-year-old patient with medically uncontrolled open-angle glaucoma despite maximally tolerated topical therapy presents to an ophthalmology ambulatory surgery center for implantation of an intracameral travoprost micro‑implant (J7355). The procedure is performed by an ophthalmologist with sterile technique under local anesthesia. Pre-procedure steps include informed consent, topical antisepsis, measurement of intraocular pressure (IOP), and marking the operative eye. The implant is delivered intracamerally via a microinjection device during a brief procedure lasting minutes. Immediate post‑procedure care includes IOP check, topical antibiotic and anti-inflammatory instillation, and instructions for activity restrictions and follow-up. Typical follow-up visits occur within 24–48 hours for IOP and wound check, then at 1 week and 1–3 months to assess IOP control and implant position. Typical site of service is an ophthalmology outpatient clinic, ambulatory surgical center (ASC), or hospital outpatient department depending on patient comorbidities and facility capabilities. Typical patient scenario: an older adult with progressive visual field loss and elevated IOP despite drops who is offered an intracameral travoprost implant to improve adherence and reduce IOP burden.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier — standard claim | Use when no special modifier applies and the service is billed as routine. |