About this policy
The comment period for the Dexamethasone Intracanalicular Ophthalmic Insert (Dextenza®) DL38792 Local Coverage Determination (LCD) began on 9/24/20 and ended on 11/7/20. The notice period for L38792 begins on 12/24/20 and will become effective on 2/7/21. No comments were received from the provider community.
Codes in this policy
Code numbers and each code’s status as the policy records it. CPT code descriptions are left out of this page, as are the passages that cite CPT codes; the official document has them.
Codes labeled “Inferred from policy title” are not listed in the policy document; Backwork attached them because the policy title names the drug.
| Code | Code system | Status in this policy |
|---|---|---|
| J1096 | HCPCS | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| J8540 | HCPCS | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |