Benzinga | Nov 5, 2021 09:44AM EDT

Ocular Therapeutix Announces Update From Centers For Medicare And Medicaid Services For Reimbursement Of DEXTENZA

Ocular Therapeutix, Inc. (NASDAQ:OCUL), a biopharmaceutical company focused on the formulation, development, and commercialization of innovative therapies for diseases and conditions of the eye, announced that the Centers for Medicare and Medicaid Services (CMS) released its final rules for the Outpatient Prospective Payment System (OPPS) and Medicare Physician Fee Schedule (MPFS) for 2022.

The OPPS final rule confirms that DEXTENZA will continue to be separately paid by Medicare in the hospital outpatient department (HOPD) and ambulatory surgical center (ASC) settings for 2022. CMS further indicated that DEXTENZA is eligible to receive separate payment in the ASC setting because it meets the criteria set forth in the non-opioid as a surgical supply provision, which is favorable for 2023 and beyond.

"We believe both the continued separate payment for 2022 and the provision facilitating continued separate payment after that are enormously exciting developments as patients will continue to have access to DEXTENZA and its clinical benefits for the foreseeable future," said Antony Mattessich, President and Chief Executive Officer of Ocular Therapeutix. "This decision effectively extends the reimbursement horizon for DEXTENZA in the surgical setting while we open a new dawn in the physician office setting with the FDA's recent approval of DEXTENZA as a treatment for ocular itching associated with allergic conjunctivitis."

The MPFS final rule establishes payment for Category I Current Procedural Terminology (CPT) Code 68841 which replaces Category III CPT Code 0356T, effective January 1, 2022. The physician payment for the insertion of DEXTENZA in the physician office is $37.29 and in the ASC or the HOPD is $31.58. The Company believes achieving Category I status for the new CPT Code represents an important milestone because Category I codes standardize payment and are more widely accepted by the payer community, resulting in broader coverage.