HCPCS drug code · CMS crosswalk
Dextenza J-Code / HCPCS Code
In short
Dextenza is billed under HCPCS J1096 — Dexamethasone, lacrimal ophthalmic insert, 0.1 mg. One billing unit is 0.1 mg. CMS's crosswalk lists 2 Dextenza NDCs under this code.
Reference
- J1096
- Dexamethasone, lacrimal ophthalmic insert, 0.1 mgBilling unit: 0.1 mg
- Labelers
- Ocular Therapeutix
Medicare Part B payment limit
CMS ASP filePayment limit per unit$87.902
Per0.1 mg
Coinsurance20%
Effective October 1, 2026 through December 31, 2026. Payment allowance limits subject to the ASP methodology are based on 2Q26 ASP data. A payment limit is not a coverage decision; the Medicare contractor decides coverage. CMS ASP pricing files
Dextenza units and claim line
Enter the dose given to get the J1096 units and the NDC line for the CMS-1500 and the 837P.
Enter the dose given to build the claim line.
Dextenza NDCs and billing units
From CMS’s ASP NDC–HCPCS crosswalk, effective October 1, 2026 through December 31, 2026. Billing units per package are CMS’s figures for the code’s unit.
| NDC (11-digit) | HCPCS | Labeler | Package | Billing units per package |
|---|---|---|---|---|
| 70382-0204-01 | J1096 | Ocular Therapeutix | 1 | 4 |
| 70382-0204-10 | J1096 | Ocular Therapeutix | 10 × 1 | 40 |
Dextenza: common questions
- What is the J-code for Dextenza?
- Dextenza is billed under HCPCS J1096 — Dexamethasone, lacrimal ophthalmic insert, 0.1 mg. One billing unit is 0.1 mg. CMS's crosswalk lists 2 Dextenza NDCs under this code.
- How many J1096 billing units are in a package of Dextenza?
- CMS lists 4 to 40 billing units per package, depending on the NDC, where one unit is 0.1 mg. Units to report are based on the dose given, not the package.
- Is J1096 a CPT code?
- No. J1096 is a HCPCS Level II code from CMS for the drug itself. Giving it, for example by injection or infusion, is usually reported with a separate CPT administration code.
Other codes for the same drug
- J1095Injection, dexamethasone 9 percent, intraocular, 1 microgram
- J1100Injection, dexamethasone sodium phosphate, 1 mg
- J7312Injection, dexamethasone, intravitreal implant, 0.1 mg
- J7637Dexamethasone, inhalation solution, compounded product, administered through dme, concentrated form, per milligram
- J7638Dexamethasone, inhalation solution, compounded product, administered through dme, unit dose form, per milligram
- J8540Dexamethasone, oral, 0.25 mg
- J8541Dexamethasone (hemady), oral, 0.25 mg