Frequently Asked Questions about DEXYCU

The latest Ambulatory Surgery Center (ASC) payment rate addendum is posted on the CMS website. This list is updated quarterly. Please bookmark the page for future access. The file posted by CMS currently lists reimbursement for J1095 (Injection, dexamethasone 9%).

Click the top hyperlink

In the Related Links section, choose the most recent date labeled “ASC Approved HCPCS Code and Payment Rates.” This will open in a new page.

Scroll to the bottom and choose “Accept”

In that new page, go down to the buttons at the bottom. Clicking the button labeled “Accept” will download a spreadsheet with the codes.

Open the downloaded spreadsheet file

The spreadsheet may be inside a folder. Open the most recent file.

Scroll down to J1095 (row 1126) to find DEXYCU

The spreadsheet window may need to be resized to see the entire page. Make sure to be in the “ASC BB” section. Scroll down to row 1126 to find the information.

Multiply unit by 517

CMS (Medicare) billing methodology for many specialty products is to the single unit of measure. For DEXYCU 1 unit =1 microgram. Allowable billing for DEXYCU is 517 units.

DEXYCU is not included in the MIPS (Merit-based Incentive Payment System) for the year 2021.

EyePoint continues to work with Congress and CMS (Centers for Medicare and Medicaid Services) on behalf of our physician community and their patients in an effort to ensure DEXYCU remains excluded from the MIPS calculation in future years.

We believe DEXYCU should remain excluded from the MIPS calculation because DEXYCU treats postoperative inflammation, similar to other comparable treatments that are currently excluded from the MIPS calculation. While we can never guarantee any current pass-through product will not be subject to MIPS, we are optimistic our efforts on behalf of you and your patients will yield a positive outcome.

CMS and its contractor Acumen develop the new episode-based cost measures with physician input, including that of ASCRS (American Society of Cataract and Refractive Surgery). An ASCRS physician continues to serve on a technical expert panel, advising CMS and Acumen on the development of the cataract and other episode measures.

Should CMS decide to update a measure for a subsequent reporting year, CMS is required to post the update for public comment. The vehicle for this would be the MPFS (Medicare Physician Fee Schedule) proposed rule, which is scheduled for release in late June/early July of each year, prior to the reporting year. At that time, when the proposed rule is released, EyePoint reviews to determine whether J1095 (DEXYCU) has been added to the measure and, if so, for which ICD-10 diagnoses. If it has, then the company can submit comments to CMS with regard to the measure.

No. Once a measure is finalized for a reporting year, any additions to HCPCS (Healthcare Common Procedure Coding System) (eg, J or Q codes) or CPT (Current Procedural Terminology) codes cannot be incorporated mid-year into the measure.

To report an adverse event, contact EyePoint Pharmaceuticals at 1-833-EYEPOINT (1-833-393-7646).