Reimbursement for DURYSTA

DURYSTA (bimatoprost implant) is a biodegradable anterior segment implant drug delivery system, containing 10 mcg of the drug. The Food and Drug Administration approved DURYSTA in March 2020.

This FAQ addresses the following:

1. What is DURYSTA™?
2. What are the indications for DURYSTA?
3. What CPT code describes the insertion of the DURYSTA implant?
4. How is the supply of DURYSTA coded?
5. Do Medicare and other third party payers cover DURYSTA and its implantation?
6. If DURYSTA and its implantation are not covered, who is financially responsible?
7. Does DURYSTA need an NDC number on a claim for reimbursement?
8. CPT code 66030 is designated as a “separate procedure”. What is the significance of this designation?
9. Is 66030 bundled with other ophthalmic services?
10. What is the surgeon’s reimbursement for 66030?
11. What is the ASC or HOPD facility reimbursement?

 

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