Does J7351 require prior authorization?

Yes, J7351 requires prior authorization (high confidence). Code explicitly requires prior authorization.

What is the Medicare reimbursement rate for J7351?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

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`J7351`, Injection, bimatoprost, intracameral implant, 1 microgram

HCPCS/CPT

Prior Authorization

Prior Auth Required

Code explicitly requires prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Individuals should be informed of potential adverse events (including cataracts, increased intraocular pressure, hypotony, endophthalmitis, and risk for additional surgical procedures) and should make an informed choice among treatment options.

Key Coverage Criteria

An intravitreal and punctum corticosteroid implant may be considered medically necessary when used as an alternative in individuals intolerant or refractory to other therapies, or in individuals likely to experience severe adverse events from systemic corticosteroids, per FDA-approved indications.
Medically necessary intravitreal and punctum corticosteroid implants when used as an alternative for those intolerant/refractory to other therapies or in individuals likely to experience severe adverse events from systemic corticosteroids.
Intravitreal implant per FDA-approved indications may be covered as an alternative for individuals intolerant or refractory to other therapies, or judged likely to experience severe adverse events from systemic corticosteroids.
Medically necessary: Retisert 0.59 mg intravitreal fluocinolone acetonide implant for chronic noninfectious uveitis affecting the posterior segment of the eye in individuals aged 12 years and older.
Prescribed by an ophthalmologist; and, Prescribed for patients with elevated intraocular pressure in open-angle glaucoma or ocular hypertension; and, Patient meets all of the following: A. Patient is unable to administer eye drops, and, B. Patient does not have a caregiver who can administer eye drops; and, Patient has tried and failed topical prostaglandin drops (e.g. [...]

12 Active Policies

ARKBLUE-BIMATOPROST-E-G-DURYSTA-04765EFD28, Bimatoprost (e.g., Durysta)

FLORIDA_BLUE-FLBLUE-BIMATOPROST-IMPLANT-DURYSTATM-A535968B79, Bimatoprost Implant (Durysta)

BCBSLA-00725-7E98593222, 00725 bimatoprost Implant (Durysta)

HEALTHPARTNERS-CC-ENTRY-287103, Prostaglandin intracameral implants: travoprost intracameral implant (iDose TR, Durysta)

MULTI

BCBSNJ-DRUGS-207-AE32BF0E1A, Bimatoprost Implant (Durysta)

HEALTHNET_OR-HNOR-BIMATOPROST-IMPLANT-DURYSTA-CP-PHAR-486-A37010E9EC, Bimatoprost Implant (Durysta); CP.PHAR.486

BCBSIL-OTH903.024, Intravitreal, Punctum, and Intracameral Implants

BCBSMT-OTH903.024, Intravitreal, Punctum, and Intracameral Implants

BCBSNM-OTH903.024, Intravitreal, Punctum, and Intracameral Implants

EVICORE-MEDICAL_DRUG-A3E42E17C648, Durysta (bimatoprost intracameral implant)

BCBSOK-OTH903.024, Intravitreal, Punctum, and Intracameral Implants

OSCAR-DURYSTA-BIMATOPROST-INTRACAMERAL-IMPLANT-CG11-ECDFCB7A77, Durysta (bimatoprost intracameral implant) (CG116, Ver. 4)

`J7351`, Injection, bimatoprost, intracameral implant, 1 microgram

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

12 Active Policies

Related Codes

Have a follow-up question?

J7351, Injection, bimatoprost, intracameral implant, 1 microgram

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

12 Active Policies

Related Codes

Have a follow-up question?

`J7351`, Injection, bimatoprost, intracameral implant, 1 microgram