Alcon Reimbursement Services (U.S. Only)
TRIESENCE® (triamcinolone acetonide injectable suspension) 40 mg/mL
NDC # 00065-0543-01
In the sections below, physicians and facilities can locate useful sample forms and quick reference documents that outline the reimbursement process for TRIESENCE® suspension. These documents should answer many of your questions and provide guidance in properly submitting your claims to Medicare and commercial payers.
Alcon has applied for a TRIESENCE® suspension specific J-code and will post that information as it becomes available. Alcon will be working directly with Medicare carriers and commercial payers to request formal coverage policies for TRIESENCE® suspension. Your claims experience will be very useful in this endeavor. Please take a moment to contact us about your reimbursement experiences related to TRIESENCE® suspension.
Guidance Documents
- Reimbursement Fact Sheet for Physician (pdf format, 75KB)
- Reimbursement Fact Sheet for Hospital Outpatient (pdf format, 75KB)
- Reimbursement Fact Sheet for Ambulatory Surgery Center (pdf format, 75KB)
- FDA Approval Letter (pdf format, 136KB)
- TRIESENCE® Suspension Product Insert (pdf format, 56KB)
Sample Forms
- Claim Form (CMS-1500) for Physician (pdf format, 150KB)
- Claim Form (UB-04) for Hospital Outpatient (pdf format, 50KB)
- Claim Form (CMS-1500) for Ambulatory Surgery Center (pdf format, 150KB)