IHEEZO Gel gains Medicare Pass-Through

On March 13, 2023, Harrow® announced that the Centers for Medicare & Medicaid Services (CMS) has approved transitional pass-through reimbursement status for chloroprocaine hydrochloride ophthalmic gel 3% (IHEEZO™), which is indicated for ocular surface anesthesia.

According to the manufacturer, IHEEZO is a sterile, single-patient use, physician-administered, ophthalmic gel preparation, containing no preservatives, for ocular surface anesthesia.  It was approved by the FDA on September 26, 2022.

Beginning April 1, and for 3 years thereafter, IHEEZO will be eligible for separate reimbursement outside of the surgical bundled payment for both the Ambulatory Surgery Center (ASC) and Hospital Outpatient Department (HOPD) settings of care.  This new CMS pass-through approval makes the gel the only ocular anesthetic with separate reimbursement in all traditional settings of care – the eyecare professional’s office, the ASC, and the HOPD.

CMS has approved the issuance of a permanent, product specific HCPCS code (J2403) for IHEEZO.

By having pass-through status, IHEEZO will be separately reimbursed by using the average sales price (pricing is the average sales price after considering any discounts) +6%, although the ASP price won’t be established until the beginning of next year.  Until then, it will be reimbursed at wholesale acquisition cost ($544) +3%.

We are happy to assist you with claims issues and other topics related to eye care.  Check back often for updated News Items related to billing, documentation, and operations related to your practices.  Stay safe.

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