Coding And Billing For JETREA® - Hospital Outpatient Department

by  Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
February 9th, 2015

Hospital Outpatient Department (HOPD):
Coding And Billing For JETREA®

The information contained below is provided for informational purposes only and is not intended to provide specific guidance on how to code, bill, or charge for any product or service. The following list provides possible codes that may relate to the use of JETREA for its approved indication and is not intended to be comprehensive. It is the sole responsibility of the provider to select proper coding for rendered products or services and to ensure the accuracy of all claims used in seeking reimbursement. ThromboGenics cannot guarantee payment of any claim.

Classification CategoryCoding SystemCodeDescriptionNotes
Diagnosis ICD-9-CM 379.27 Vitreomacular adhesion, vitreomacular traction1,*
  • Effective as of
    October 2011
Administration Procedure CPT Code 67028 Intravitreal injection of a pharmacologic agent2
  • CPT modifiers to document
    affected eye2
    • RT – Right side
    • LT – Left side
Drug Code HCPCS NEW:
Effective 1/1/14
0.125 mg3
  • Reported as 4 units for a single-use vial
C9298 Injection, Ocriplasmin,
0.125 mg4
  • Reported as 4 units for a single-use vial
NDC 24856-0001-00 One single-use vial of JETREA5
  • 11-digit format is generally preferred for medical claims
    (10-digit format is 24856-001-00)

*Excludes traction detachment with vitreoretinal organization (361.81).
Effective as of January 1, 2014
Effective as of April 1, 20134



Coding And Billing For JETREA® - Hospital Outpatient Department. (2015, February 9). Find-A-Code Articles. Retrieved from

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