• Separate Billing of Photrexa with Corneal Cross-linking


    Question: When performing corneal cross-linking (CXL), do payers allow for separate billing of Photrexa?

    Answer: Yes. Payers always have covered the drug separately. Effective Jan. 1, 2020 the Category III code 0402T updated the description to include “Report medication separately.”

    Practices can separately report J2787 Riboflavin 5’- Phosphate, ophthalmic solution, up to 3 ml. Submit two units. If the second vial is wasted, be sure to submit with modifier -JW. Verify coverage benefits for federal and commercial payers for both 0402T and J2787.

    More information can be found in our Fact sheet.