Dexycu® (dexamethasone intraocular suspension)
Not covered for Traditional, Optimized, or Medicaid plans.
Medicare Part B coverage: No authorization required.
No prior authorization required for:
- Emergency room
- Skilled nursing facility
Injectable auth/billing notes:
Medications billed with miscellaneous codes will be reviewed. Explanatory notes must accompany the claim.
Priority Health Medicare applies CMS local coverage determination criteria when available for Part B drugs.
Code(s): J3490, C9034
Notes: Treatment for inflammation associated with cataract surgery
Criteria for coverage: See PA forms