CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Implantation of Anterior Segment Intraocular Nonbiodegradable Drug-Eluting System

This policy governs coverage for implantation of anterior segment intraocular non-biodegradable drug-eluting systems (an intracameral travoprost implant) for BCBSRI members and Medicare Advantage enrollees. It states the payer's coverage stance and applicable billing codes.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyImplantation of Anterior Segment Intraocular Nonbiodegradable Drug-Eluting System

Policy CodePolicy N/A

Change TypeNo material change

Effective DateOct 1, 2024

Next Review DateN/A

Key ActionDo not submit claims for codes 0660T or J7355 as they are considered not covered / not medically necessary and may be denied.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Not medically necessaryCommercial coverage stance

0660T, J7355Listed codes

FDA-approvedRegulatory status

Not applicablePrior auth

Coverage Determination and Criteria

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Not medically necessary / Insufficient evidence

Covered when ALL of the following are met:

Primary coverage stance: Implantation of anterior segment intraocular non-biodegradable drug-eluting system (intracameral travoprost implant) is not covered / is not medically necessary because the evidence is insufficient to determine that the technology results in an improvement in net health outcome.

Applies to Commercial Products and Medicare Advantage as specified.

Benefits for implantation of an anterior segment intraocular non-biodegradable drug-eluting system can vary by member contract. Providers should verify coverage by reviewing the member's Benefit Booklet, Evidence of Coverage, or Subscriber Agreement for any contract-specific limitations, exclusions, or member cost-sharing that apply to this service.

For Commercial Products, implantation of an anterior segment intraocular non-biodegradable drug-eluting system is stated as not medically necessary. The policy concludes the available evidence is insufficient to demonstrate that the technology improves net health outcome, and therefore the service is not covered for commercial members under this policy.

Provider Requirements and Billing Implications

Prior Authorization

Prior Authorization Required

Prior authorization: Not applicable.

Step Therapy

Step Therapy / Clinical Criteria

No medical criteria or step therapy requirements specified. There are no documented step therapy or medical-necessity criteria for implantation of anterior segment intraocular non-biodegradable drug systems.

Documentation Required

Benefit Verification

Providers should verify member benefits and coverage limitations prior to providing services. Check the member's Benefit Booklet, Evidence of Coverage, or Subscriber Agreement for applicable benefits, medical necessity determinations, and any exclusions that may apply.

Verify benefits and eligibility via member's benefit booklet, Evidence of Coverage, or Subscriber Agreement.
Contact the provider call center for member-specific benefit information.

Denial Risk

Denial Risk for Listed Codes

Claims for the device and listed codes (e.g., 0660T, J7355) are at risk of denial because the service is not covered or considered not medically necessary per this policy. Surface these codes on claims and confirm payer stance with benefit verification before performing or billing for the service.

Affected codes: 0660T — Implantation of anterior segment intraocular nonbiodegradable drug-eluting system, internal approach.
Affected codes: J7355 — Injection, travoprost, intracameral implant; 1 microgram (New Code Effective 7/1/2024).

Background

Drug-eluting intraocular devices are being developed to address challenges with adherence to topical ocular therapies by providing continuous intraocular delivery of medication. The anterior segment intracameral travoprost implant is designed to be anchored through the trabecular meshwork and elute a prostaglandin analogue over an extended period to lower intraocular pressure, with the goal of reducing the need for frequent eye-drop dosing and improving sustained therapeutic effect.

Definitions

Anterior segment intraocular non-biodegradable drug‑eluting system — key facts

Device descriptionIntracameral implant anchored through the trabecular meshwork into the sclera that continuously delivers travoprost (prostaglandin analog) intracamerally to lower intraocular pressure.

Drug formulationProprietary preservative‑free formulation of travoprost eluted from within the eye over an extended period.

Intended indicationReduction of intraocular pressure in patients with open‑angle glaucoma or ocular hypertension.

Surgical approachImplantation performed via an internal (intracameral) approach.

Regulatory statusFDA approved (PMA/505(b)(2) pathway) on December 13, 2023.

Evidence summary / policy stanceNot identified as widely used or generally accepted; evidence insufficient to establish net health benefit for proposed uses.