Jetrea® (ocriplasmin)

No prior authorization required for:

  • Emergency room
  • Inpatient
  • 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): J7316

Benefit: Medical


  • Treatment of vitreomacular adhesion
  • No prior authorization required
  • Covered only for diagnoses H43.821-H43.829, vitreomacular adhesion