Avedro announced that the Centers for Medicare and Medicaid Services (CMS) has issued a preliminary decision to establish a product specific Healthcare Common Procedure Coding System (HCPCS) J code for Photrexa drug formulations. Claims submitted with a product specific J code are generally processed more efficiently than claims using a miscellaneous code (J3490), which requires manual review.
These Photrexa formulations are the only drugs approved by the FDA for use in conjunction with the KXL System in corneal collagen cross-linking to treat progressive keratoconus and corneal ectasia following refractive surgery.
“We are pleased that CMS has recommended a unique J code for our Photrexa drugs,” Reza Zadno, PhD, CEO of Avedro, said in a company news release. “We would like to thank the ophthalmologists, the societies and the National Keratoconus Foundation for working with us in this collaborative effort. Finalization of this recommendation would be an important achievement for the company as we continue our efforts to make corneal cross-linking an accessible procedure for patients struggling with sight-threatening diseases.”
“If finalized, this J code will simplify billing for the FDA approved corneal cross-linking procedure,” Eric Donnenfeld, MD, founding partner of Ophthalmic Consultants of Long Island and Connecticut, said in the news release. “A product specific J code will streamline the claims submission process for physician practices and better serve ectactic patients in need of treatment.”
CMS’ preliminary decision was announced at their public meeting held on Tuesday, May 15, 2018, and is expected to be finalized and announced in November of 2018, with new or revised codes becoming effective on January 1, 2019.