Ophthalmic medical technology company Avedro, Inc. announced yesterday that the Centers for Medicare and Medicaid Services (CMS) issued a product-specific J code, J2787, for Photrexa® Viscous (riboflavin 5’-phosphate in 20% dextran ophthalmic solution) and Photrexa® (riboflavin 5’-phosphate ophthalmic solution). These Photrexa formulations are the only drugs approved by the U.S. Food and Drug Administration (FDA) for use in corneal collagen cross-linking for the treatment of progressive keratoconus and corneal ectasia following refractive surgery.
J2787 will become effective on January 1, 2019, under the Healthcare Common Procedure Coding System (HCPCS) and is expected to stabilize payment policies and facilitate the billing process for physician practices and their patients. J codes are developed and issued by CMS as part of the HCPCS coding system for reporting medical procedures and services. Once effective, physicians will be able to use J2787 to submit claims for Photrexa Viscous and Photrexa to commercial payors.
“We expect the permanent J code to positively impact patients and physician practices by providing much needed coding clarity. This achievement reflects the hard work, persistence and collaboration of ophthalmologists, the American Academy of Ophthalmology, the American Society of Cataract and Refractive Surgery, the Cornea Society and the National Keratoconus Foundation,” said Reza Zadno, PhD, Chief Executive Officer of Avedro.
"Our recently expanded reimbursement team will immediately begin the process of informing payors and providers of this exciting change. We believe this new J code, and the fact that over 55 private payors now cover medically necessary corneal cross-linking, will help ensure that this procedure is even more accessible to patients struggling with keratoconus, a sight-threatening disease.”
Patients can find the list of private payor insurance companies providing coverage for corneal cross-linking here: https://www.livingwithkeratoconus.com/