SAVINGS: PRIOR AUTHORIZATION, BILLING & CODING
Helpful information for your office
To submit a Prior Authorization, your office may need this information
In the event a Prior Authorization is necessary, give a brief summary of the rationale for treatment with CEQUATM, including:
A description of the diagnosis, International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) code, severity of the patient’s condition, symptoms, and age
Previous therapies such as over-the-counter and prescription medications, reasons for discontinuation, and duration of therapy
Clinical support for the appeal
Evidence for your recommendation
Relevant codes when billing and coding for CEQUA
The following is an overview of current relevant codes that may be potential options for use with CEQUA:
| ICD-10-CM | Description |
|---|---|
| H16.223 | Keratoconjunctivitis sicca, not specified as Sjögren’s, bilateral |
| H04.121 | Dry eye syndrome of the right lacrimal gland |
| H04.122 | Dry eye syndrome of the left lacrimal gland |
| H04.123 | Dry eye syndrome of the bilateral lacrimal glands |
| H04.129 | Dry eye syndrome of unspecified lacrimal gland |
CEQUA is indicated for use in patients with keratoconjunctivitis sicca1
Resources to Help You Get Started
Indications and Usage
CEQUATM (cyclosporine ophthalmic solution) 0.09% is a calcineurin inhibitor immunosuppressant indicated to increase tear production in patients with keratoconjunctivitis sicca (dry eye).
Important Safety Information
Warnings and Precautions
Potential for Eye Injury and Contamination: To avoid the potential for eye injury and contamination, advise patients not to touch the vial tip to the eye or other surfaces.
Use with Contact Lenses: CEQUA should not be administered while wearing contact lenses. If contact lenses are worn, they should be removed prior to administration of the solution. Lenses may be reinserted 15 minutes following administration of CEQUA ophthalmic solution.
Adverse Reactions
The most common adverse reactions reported in greater than 5% of patients were pain on instillation of drops (22%) and conjunctival hyperemia (6%). Other adverse reactions reported in 1% to 5% of patients were blepharitis, eye irritation, headache, and urinary tract infection.
Please see the Full Prescribing Information.
Indications and Usage
CEQUATM (cyclosporine ophthalmic solution) 0.09% is a calcineurin inhibitor immunosuppressant indicated to increase tear production in patients with keratoconjunctivitis sicca (dry eye).
Important Safety Information
Warnings and Precautions
Potential for Eye Injury and Contamination: To avoid the potential for eye injury and contamination, advise patients not to touch the vial tip to the eye or other surfaces.
Use with Contact Lenses: CEQUA should not be administered while wearing contact lenses. If contact lenses are worn, they should be removed prior to administration of the solution. Lenses may be reinserted 15 minutes following administration of CEQUA ophthalmic solution.
Adverse Reactions
The most common adverse reactions reported in greater than 5% of patients were pain on instillation of drops (22%) and conjunctival hyperemia (6%). Other adverse reactions reported in 1% to 5% of patients were blepharitis, eye irritation, headache, and urinary tract infection.
Please see the Full Prescribing Information.
Reference: 1. CEQUA [package insert]. Cranbury, NJ: Sun Pharmaceutical Industries, Inc.; 2019.
