January 25, 2022 - Updated 04.30.24
Triamcinolone Acetonide Injectable Suspension, for Suprachoroidal Use (Xipere™) Billing and Coding Instructions
Xipere™ is an FDA-approved corticosteroid injection for the treatment of macular edema associated with uveitis. Xipere is available as a single-use suprachoroidal microinjector.
Coding for Xipere™
Report the following information on your claim to Medicare:
- HCPCS code J3299 for the drug
- CPT code 67516 for the injection procedure
- ICD-10 diagnosis code for uveitis AND macular edema that aligns with FDA-labeled use for this product, such as:
Non-infectious Uveitis
- Anterior uveitis
- Primary iridocyclitis (H20.011, H20.012, H20.013)
- Recurrent acute iridocyclitis (H20.021, H20.022, H20.023)
- Intermediate uveitis (H30.21, H30.22, H30.23)
- Panuveitis (H44.111, H44.112, H44.113)
- Posterior uveitis
- Exudative retinopathy (H35.021, H35.022, H35.023)
- Retinal vasculitis (H35.061, H35.062, H35.063)
- Focal chorioretinal inflammation, juxtapapillary (H30.011, H30.012, H30.013)
- Focal chorioretinal inflammation of posterior pole (H30.021, H30.022, H30.023)
- Focal chorioretinal inflammation, peripheral (H30.031, H30.032, H30.033)
- Focal chorioretinal inflammation, macular or paramacular (H30.041, H30.042, H30.043)
- Disseminated chorioretinal inflammation posterior pole (H30.111, H30.112, H30.113)
- Disseminated chorioretinal inflammation, peripheral (H30.121, H30.122, H30.123)
- Disseminated chorioretinal inflammation, generalized (H30.131, H30.132, H30.133)
- Other chorioretinal inflammations (H30.891, H30.892, H30.893)
- Harada’s disease (H30.811, H30.812, H30.813)
- Vogt-Koyanagi Syndrome (H20.821, H20.822, H20.823)
- Cystoid macular degeneration (H35.351, H35.352, H35.353)
- Retinal edema (H35.81)
- Anterior uveitis
NOTE: Unlabeled use of the drug is subject to review on a case-by-case basis and must meet the reasonable and necessary criteria described in the Medicare Benefit Policy Manual (Pub. 100-02), chapter 15, section 50.4.2 – Unlabeled Use of Drug.