Implantation of Anterior Segment Intraocular Nonbiodegradable Drug-Eluting System
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Policy governs coverage and medical necessity determinations for implantation of anterior segment intraocular non-biodegradable drug-eluting systems (e.g., intracameral travoprost implant) for treatment of glaucoma or ocular hypertension for Blue Cross Blue Shield - Rhode Island members.
No material clinical or coverage changes in this revision.
Coverage Criteria and Determinations
Coverage stance
Coverage determinations for implantation of anterior segment intraocular non-biodegradable drug-eluting systems:
Benefits and covered services can vary by specific group or contract. Refer to the member’s Benefit Booklet, Evidence of Coverage, or Subscriber Agreement to determine whether implantation of anterior segment intraocular non-biodegradable drug‑eluting systems is included or excluded under that member’s plan.
For Commercial Products, implantation of anterior segment intraocular non‑biodegradable drug‑eluting systems is considered not medically necessary because the evidence is insufficient to demonstrate an improvement in net health outcome. The policy identifies the related procedure and drug codes as 0660T (implantation of anterior segment intraocular nonbiodegradable drug‑eluting system, internal approach) and J7355 (injection, travoprost, intracameral implant, 1 microgram). Verify member benefits prior to scheduling, as coverage may vary by contract.
Procedure and Drug Codes
| 0660T | Implantation of anterior segment intraocular nonbiodegradable drug-eluting system, internal approach |
| J7355 | Injection, travoprost, intracameral implant, 1 microgram (New Code Effective 7/1/2024) |
Provider Requirements, Authorization, and Billing Notes
Prior authorization not applicable
Prior authorization is not required under this policy for implantation of anterior segment intraocular non-biodegradable drug-eluting systems; verify member-specific coverage before proceeding.
No step therapy required / device for poor adherence
No step therapy requirements are specified in this policy; the device is described as an option developed to address poor adherence to topical eye medications.
Verify benefits and document medical necessity
Verify member benefits and eligibility against the Benefit Booklet, Evidence of Coverage or Subscriber Agreement and document medical necessity discussions and member agreement if proceeding with services that may be non‑covered.
- Confirm benefits and coverage specifics with the member's subscriber documents or provider call center.
- Document medical necessity rationale and obtain written member agreement if providing non‑covered services.
Denial risk: not covered / not medically necessary
Claims for implantation of anterior segment intraocular non-biodegradable drug-eluting systems are not covered for Medicare Advantage members and are considered not medically necessary for Commercial members due to insufficient evidence of improved net health outcome.
- Do not bill expecting coverage for Medicare Advantage members.
- For Commercial members, document discussions if proceeding despite not medically necessary determination.
Background and Rationale
Drug‑eluting anterior segment intraocular implants were developed to address poor adherence to topical glaucoma medications by providing sustained intracameral delivery of intraocular pressure‑lowering medication. An example is the travoprost intracameral implant (iDose TR®), which is designed as a sustained‑release micro‑invasive intracameral device to continuously deliver travoprost and reduce intraocular pressure in patients with open‑angle glaucoma or ocular hypertension.
Definitions and Device Examples
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