The U.S. Centers for Medicare and Medicaid Services (CMS) has granted Glaukos Corporation a permanent J-code for its newly launched iDose TR (travoprost intracameral implant) 75 mcg.
Refresh me on the iDose TR.
Approved by the FDA in December 2023 and commercially launched in the U.S. just last month, the iDose TR is a biocompatible titanium implant designed to be administered during micro-invasive glaucoma procedures.
The device consists of a proprietary, preservative-free formulation of (75 mcg) travoprost pre-loaded in a single-dose insert and released inside the anterior chamber.
Click here to learn about the iDose TR’s (a prostaglandin analog) intraocular pressure (IOP)-lowering effects, as well as its mechanism of action.
And the implant’s indication?
The iDose TR is indicated to reduce IOP in patients with open-angle glaucoma or ocular hypertension (OHT).
The duration of its effects: Based on clinical data, it's been shown to reduce the burden of topical IOP-lowering medications for up to 36 months.
See its prescribing information (PI) for more details.
How did it perform in clinical trials?
In January 2023, phase 2b trial data reported the iDose TR demonstrated a favorable safety profile over a 12-month evaluation period. See our coverage here.
Prior to that, two pivotal phase 3 trials found the implant to have “a fast- and slow-release capacity against twice-daily (BID) topical timolol ophthalmic solution, 0.5% (the active comparator) over 12 months,” Glaukos reported.
Click here for those details.
Now explain a J-code.
A J-code is a permanent reimbursement designation issued by the Healthcare Common Procedure Coding System (HCPCS) Level II code for a non-orally administered drugs and other medical devices.
Note: the HCPCS standardizes claims for medical services and supplies.
Plus, this type of code is also used by the U.S. government and commercial payers (not to mention surgeons) to simplify and facilitate the billing and reimbursement process for medical providers’ products and services.
And this compares to other HCPCS codes by …. ?
Here’s a breakdown of the three major codes:
- J-codes (J0120 - J8999) refer to drugs administered via routes that exclude oral methods.
- C-codes (C1713 - 9899) refer to the outpatient prospective patient system (OPPS).
- V-codes (V2020 - V2799) refer to vision services.
So what is the iDose TR’s new code?
Per CMS: J7355.
See it here (scroll to page 17).
And when is this effective?
July 1, 2024.
What else to know?
Glaukos also reported that, as a result of the CMS issuing the April 2024 Update of the Hospital Outpatient Prospective Payment System (OPPS) transmittal, the following CPT codes were assigned to cover the procedural component to ambulatory payment classification (APC) 5492 (Level 2 Intraocular Procedures) that the iDose TR would fall under:
- CPT code: O660T
- CPT code: 0661T