Omeros announced that the product specific J-code for Omidria (phenylephrine and ketorolac intraocular solution) 1%/0.3% is now effective. Omidria is Omeros’ commercial drug marketed for use during cataract surgery to prevent miosis and reduce postoperative pain.
The new permanent J-code for Omidria, J1097, replaces the previous temporary C-code C9447. J-codes are reimbursement codes used by commercial insurance plans, Medicare, Medicare Advantage, and other government payers for Medicare Part B drugs like Omidria that are administered by a physician. Availability of the new J-code is expected to expand reimbursement and enhance patient access to the clinical benefits of Omidria, which, in a growing body of real-world evidence, has been shown to prevent intraoperative floppy iris syndrome, to decrease the incidence of sight-threatening cystoid macular edema and to reduce both the use of opioids and steroids.
Benefits of the new J-code include having one consistent billing code that can be used across all government and commercial payer plans as well as expanding coverage in state Medicaid and commercial plans that recognize J-codes, but not C-codes, for reimbursement.
CMS announced the new J-code for Omidria in July, allowing time for Medicare Administrative Contractors as well as Medicare Advantage plans and commercial payers to program the new code into their systems in advance of the October 1 effective date. Omeros has confirmed that the new Omidria J-code has been broadly uploaded to Medicare and commercial payer systems nationwide.