Implantation of Anterior Segment Intraocular Nonbiodegradable Drug-Eluting System
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Policy governing coverage and medical necessity for implantation of anterior segment intraocular non-biodegradable drug-eluting systems (intracameral travoprost implant) for treatment of glaucoma or ocular hypertension for BCBSRI members.
No material clinical or coverage changes in this revision.
Coverage and Medical Necessity Determinations
Coverage Determinations
Coverage determinations:
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The following procedure and supply codes are identified as not covered / not medically necessary for Medicare Advantage Plans and Commercial Products: 0660T — Implantation of anterior segment intraocular nonbiodegradable drug-eluting system, internal approach; and J7355 — Injection, travoprost, intracameral implant, 1 microgram (new code effective 7/1/2024).
For Commercial Products, implantation of an anterior segment intraocular non-biodegradable drug-eluting system is considered not medically necessary. The policy concludes the available evidence is insufficient to determine an improvement in net health outcome, and therefore this technology does not meet the plan’s criteria for medical necessity.
Procedure and Supply Codes
Provider Actions, Authorization, and Billing Guidance
Prior Authorization
No prior authorization requirement specified in this policy.
Step Therapy / Medical Criteria
No medical criteria or step therapy requirements are listed in this policy.
Benefit / eligibility verification
Providers should verify member benefits, eligibility, and coverage details prior to rendering services. Benefit determinations (including whether a service is a non-covered benefit or not medically necessary) are governed by the member's Benefit Booklet, Evidence of Coverage or Subscriber Agreement and the employer agreement. For member-specific benefit information or verification, contact the provider call center.
Coverage Denial Triggers
Claims for implantation and intracameral travoprost implant supply are not covered / not medically necessary per this policy. specifically: implantation of anterior segment intraocular non-biodegradable drug-eluting system (CPT 0660T) and intracameral travoprost implant, 1 microgram (J7355) are listed as not covered for Medicare Advantage and not medically necessary for Commercial Products.
Background and Rationale
These drug-eluting anterior segment intraocular implants (for example, the iDose TR) were developed to address poor adherence to topical glaucoma medications by providing sustained intracameral delivery of travoprost over an extended period. The device is anchored through the trabecular meshwork and elutes medication to lower intraocular pressure; the manufacturer reports FDA approval for iDose TR on December 13, 2023.
Device Definitions
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