Dexamethasone Intracanalicular Ophthalmic Insert (Dextenza)
National · Effective May 26, 2022
3 active Medicare policies list J8540, and 7 commercial payer policies list it. See each policy's status for the code and its official source. Listing a code is not a coverage decision: read each policy’s source for the requirements that apply.
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National · Effective May 26, 2022
National · Effective Jan 1, 2026
National · Effective Dec 24, 2020
7 policies from 5 payers
Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.
Codes labeled “Inferred from policy title” are not listed in the policy document; Backwork attached them because the policy title names the drug.
| Policy | Effective | Status of J8540 |
|---|---|---|
| Glaucoma Surgery | Mar 24, 2023 | Covered |
| Vitiligo | Feb 16, 2024 | Covered |
| Policy | Effective | Status of J8540 |
|---|---|---|
| 00564 Select Dexamethasone Packs | Not recorded | Covered with conditionsInferred from policy title |
| 00744 Hemady (dexamethasone) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Policy | Effective | Status of J8540 |
|---|---|---|
| Dexamethasone intraocular suspension (e.g., DEXYCU) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J8540 |
|---|---|---|
| Dexamethasone Implant (Ozurdex) | Dec 1, 2016 | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J8540 |
|---|---|---|
| Dexamethasone Intravitreal Implant (Ozurdex)Effective 12/01/2018 - 10/31/2019 | Dec 1, 2018 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |