Perspective

CMS issues J code for Photrexa formulations

CMS has issued a product-specific J code for Photrexa formulations used in corneal collagen cross-linking, Avedro announced in a press release.

J2787 will become effective on Jan. 1, 2019, for Photrexa (riboflavin 5’-phosphate ophthalmic solution) and Photrexa Viscous (riboflavin 5’-phosphate in 20% dextran ophthalmic solution), the only FDA-approved drugs for use in cross-linking for patients with progressive keratoconus and cornea ectasia following refractive surgery.

“We expect the permanent J code to positively impact patients and physician practices by providing much needed coding clarity,” Avedro CEO Reza Zadno, PhD, said in the release. “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.”

CMS has issued a product-specific J code for Photrexa formulations used in corneal collagen cross-linking, Avedro announced in a press release.

J2787 will become effective on Jan. 1, 2019, for Photrexa (riboflavin 5’-phosphate ophthalmic solution) and Photrexa Viscous (riboflavin 5’-phosphate in 20% dextran ophthalmic solution), the only FDA-approved drugs for use in cross-linking for patients with progressive keratoconus and cornea ectasia following refractive surgery.

“We expect the permanent J code to positively impact patients and physician practices by providing much needed coding clarity,” Avedro CEO Reza Zadno, PhD, said in the release. “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.”

    Perspective
    Kenneth A. Beckman

    Kenneth A. Beckman

    Avedro Inc. announced that the CMS has 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 formulations of riboflavin are FDA approved to be used for corneal cross-linking for keratoconus and post-LASIK ectasia. This decision will finally allow access to cross-linking for thousands of patients with this sight threatening yet treatable condition.

    As we all know, keratoconus leads to a progressive weakening and thinning of the cornea, often requiring corneal transplantation. The disease typically presents in the second decade of life and may progress very rapidly in young patients. Prior to the approval of cross-linking, ophthalmologists had to watch helplessly as their patients’ vision deteriorated until they needed surgery. Once cross-linking was approved, access to the treatment was still limited due to the cost and lack of insurance coverage. Finally, with the new J code, this sight saving procedure may be offered to countless patients who could not otherwise afford treatment. Hopefully, with the newfound access to this procedure, a generation of young patients may be treated while their vision is still good, and then they may never go on to need corneal transplants later. Not only will this save sight for so many patients, it will save so much money for the system by decreasing the need for transplantation when it is truly avoidable.

    • Kenneth A. Beckman, MD, FACS
    • OSN Cornea/External Disease Board Member

    Disclosures: Beckman reports he is a consultant for Avedro.