Home › Drug Codes › J Codes › J1096 · DEXTENZA
Updated July 1st, 2026

DEXTENZA J Code: J1096

Dexamethasone, lacrimal ophthalmic insert, 0.1 mg

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Q4 2026 Medicare Payment Limit for J1096, effective October 1, 2026: $87.902 per HCPCS billing unit, down 2.4% from $90.019. From CMS's final file.

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Medicare Payment Limit ?
$90.019
/ HCPCS billing unit · Q3 2026
APC Payment Limit ?
$90.019
/ HCPCS billing unit · APC 9308
ASP ?
$•••.••
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WAC · AWP ?
$•••.••
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NDCs Crosswalked ?
2
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Drug & Product Overview

HCPCS Descriptor Dexamethasone, lacrimal ophthalmic insert, 0.1 mg
HCPCS Added Date October 1, 2019
Manufacturer Ocular Therapeutix
Route of Administration Intracanalicular, Ophthalmic
Generic Status Single-Source; Branded
Dosage Type Single-Dose
Dosage Form Insert

About DEXTENZA

Dextenza is a medication aligned to the HCPCS J Code: J1096 for billing, pricing, and reimbursement purposes in the United States. It is an Ophthalmology drug administered via the intracanalicular or ophthalmic routes and manufactured by Ocular Therapeutix.

According to CMS Drug Use Information: Drug uses not available

Disclaimer: This is a summary and does not contain all possible information about this product. For complete information about this product or your specific health needs, ask your healthcare professional.

NDC Code Information

Based on publicly available CMS files. The list of NDCs below is not exhaustive.

NDC Code Drug Manufacturer Billing Units / Pkg Package Size
70382-0204-01 Dextenza Ocular Therapeutix, Inc. 4 .4 MG
70382-0204-10 Dextenza Ocular Therapeutix, Inc. 40 .4 MG
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DEXTENZA Pricing & Reimbursement

J1096 Private Payer Reimbursement
$101.23 / HCPCS unit as of Jan 2026

National median reimbursement across major commercial payers.

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UnitedHealthcare, BlueCross BlueShield, Aetna, Cigna

Historical Graphing and Billing Calculator

per HCPCS unit
As of Q3 2026

Dexamethasone 505(b)(2) Information:

HCPCS Code Manufacturer Active Ingredient HCPCS Description
J1095 EyePoint Pharmaceuticals US Dexamethasone Injection, dexamethasone 9 percent, intraocular, 1 microgram
J1096 Ocular Therapeutix Dexamethasone Dexamethasone, lacrimal ophthalmic insert, 0.1 mg
J8541 Generic Code (Multiple Manufacturers) Dexamethasone Dexamethasone (hemady), oral, 0.25 mg

DEXTENZA Medically Unlikely Edits (MUE)

The most billing units of J1096 Medicare will pay for one patient in one day, as published by CMS. 1 unit = 0.1 mg.

Practitioner Office & Hospital Outpatient
8 units / day
= 0.8 mg per day

MAI 2 · Date of Service Edit: Policy. Absolute per-day limit set by policy or regulation; units above it are not payable, and denials are not appealable on medical-necessity grounds. See all MUE limits →

mg Enter a dose to see how many billing units it is and whether it is under the limit.
JW / JZ modifiers apply

CMS has identified Dextenza (J1096) as a HCPCS code with single-dose containers. Therefore, the JW/JZ wastage modifiers could be required for billing purposes. Wastage billing guide →

DEXTENZA Clinical Information

Indications and drug classification.

Treated Diseases & Conditions

This list of indications is not exhaustive and may be subject to errors. The information on BuyandBill.com is intended for informational purposes only and should not be used for medical advice.

Ocular inflammation and pain following ophthalmic surgery Ocular itching associated with allergic conjunctivitis
Drug Class
Corticosteroid Hormone Receptor Agonists [MoA]Corticosteroid [EPC]

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Frequently Asked Questions

Is there an available Dextenza billing and coding guide?
Billing and coding information for DEXTENZA can be found through Ocular Therapeutix. Visit Here →
Are there any available Dextenza patient assistance programs?
DEXTENZA patient assistance information can be found through Ocular Therapeutix. Visit Here →
Where can I find Dextenza prescribing information?
DEXTENZA prescribing information can be found at the link below: Visit Here →
Where can I find Dextenza side effect information?
Our team has not yet identified a source of side effects information for DEXTENZA. Please check back in a few weeks.
Does billing DEXTENZA require JZ/JW wastage modifiers?
CMS has identified DEXTENZA(J1096) as a HCPCS code with single-dose containers. Therefore, the JW/JZ wastage modifiers could be required for billing purposes. See CMS guidelines on use of the JZ and JW wastage modifiers below.

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