Ozurdex Pricing Update
The Centers for Medicare & Medicaid Services (CMS) has clarified the pricing for Ozurdex (dexamethasone, intravitreal) when billed using HCPCS Level II code J3490 Unclassified drugs with a description of “Ozurdex” in Item 19 of the CMS-1500 claim form or its electronic equivalent.
Ozurdex is an implant injected into the eye (vitreous) to treat adults with macular edema following branch retinal vein occlusion (BRVO) or central retinal vein occlusion (CRVO).
Effective for claims processed on or after Jan. 28, 2010 with dates of service on or after June 17, 2009, Part A/B Medicare Administrative Contractor (A/B MAC) Noridian Administrative Services (NAS) says it will allow 106 percent of the wholesale acquisition cost.
Providers who believe they were inappropriately paid by NAS for relevent claims concerning J3490 should call the Provider Contact Center at (800) 933-0614 to request a revision.