Intravitreal and Punctum
Customize your policy alerts
Sign up for all Blue Cross Blue Shield - Rhode Island policy alerts
Know when Blue Cross Blue Shield - Rhode Island releases new policies or updates existing guidance.
Monitor payer policy activity
This policy governs coverage and coding for four intravitreal corticosteroid implants and one intracanalicular dexamethasone insert for Medicare Advantage and Commercial Products. Final coverage is subject to applicable member benefit documents.
No material clinical or coverage changes in this revision.
Covered Coding
| J1096 | Dexamethasone, lacrimal ophthalmic insert, 0.1 mg |
| J7311 | Injection, fluocinolone acetonide, intravitreal implant (Retisert), 0.01 mg |
| J7312 | Injection, dexamethasone, intravitreal implant, 0.1 mg |
| J7313 | Injection, fluocinolone acetonide, intravitreal implant (Iluvien), 0.01 mg |
| J7314 | Injection, fluocinolone acetonide, intravitreal implant (Yutiq), 0.01 mg |
| 68841 | Insertion of drug-eluting implant, including punctal dilation when performed, into lacrimal canaliculus, each |
Provider Coverage Actions
Verify member-specific benefits
Confirm coverage and eligibility under the member’s applicable Evidence of Coverage, Subscriber Agreement, member certificate, and employer agreement before providing services. Benefits may vary by group or contract, and those documents supersede this policy.
Policy Background
Intravitreal implants are drug-delivery systems injected or surgically implanted in the vitreous of the eye to provide sustained medication release to the posterior and intermediate eye segments. This policy reviews four corticosteroid implants: fluocinolone acetonide implants Retisert, Iluvien, and Yutiq, and the bioerodible dexamethasone implant Ozurdex. Fluocinolone acetonide implants are nonerodible and deliver medication for up to 30 to 36 months, while dexamethasone implants are bioerodible and last up to 6 months.
Punctum implants are drug-delivery devices inserted through the lower lacrimal punctum into the canaliculus for sustained release of medication to the ocular surface. The policy reviews Dextenza, a dexamethasone ophthalmic insert and the first corticosteroid intracanalicular insert.
Device Definitions
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.