HCPCS Code J2787: Riboflavin 5'-phosphate, ophthalmic solution, up to 3 ml

Explore HCPCS Code J2787 for riboflavin ophthalmic solution, including documentation, billing, and coverage tips.

## **What is HCPCS code J2787?** HCPCS code J2787 refers to riboflavin 5'-phosphate ophthalmic solution, up to 3ml, most commonly used in corneal collagen cross-linking (CXL) procedures. This treatment strengthens the corneal structure in patients with progressive keratoconus or post-LASIK ectasia, helping to slow or stop disease progression. Since CXL is still classified under category III CPT codes and considered a new technology code, coverage policy for cases with documented progression of keratoconus presents specific challenges for providers. These challenges include navigating unspecified J codes, varying fee schedules, and ensuring proper documentation in chart notes. The drug is marketed under brand names such as Photrexa and Photrexa Viscous, and its use requires specialized systems like the KXL system. Proper billing for J2787 riboflavin 5'-phosphate ophthalmic solution is essential to support insurance payment and insurance reimbursement, avoid claims denials, and ensure patients can access this sight-preserving treatment.

## **Documentation requirements** When submitting claims for HCPCS code J2787 (riboflavin 5’-phosphate ophthalmic solution, up to 3 ml), thorough and accurate documentation is essential. Here are the documentation requirements you need to keep in mind: ### **Clinical indication and patient eligibility** Document that the patient has progressive keratoconus or corneal ectasia after refractive surgery, confirmed through diagnostic criteria such as corneal mapping, topography, or pachymetry. Coverage often requires evidence of disease progression, such as increased keratometry values or a decrease in corneal thickness. ### **Medication volume and units** Clearly record using two units of HCPCS code J2787 to reflect the typical usage of 6 mL of riboflavin solution (each unit equals 3 mL) in a single corneal collagen cross-linking (CXL) procedure. ### **Drug identification and coding notes** Include the NDC number for the Photrexa kit—25357-025-03—or the 11-digit version using a leading zero (25357-0025-03) when required by payer systems. Ensure these details are included prominently in documentation. ### **Procedure details and billing context** Note that the corneal collagen cross-linking procedure (CXL) is billed separately using CPT Category III code 0402T, while the drug (riboflavin solution) is billed via HCPCS code J2787. Confirm both codes are used properly to support the full treatment claim. ### **Payer policy and claim submission challenges** Provide evidence of payer coverage policy status, whether a positive coverage policy or a negative coverage policy exists, by referencing payer-specific guidance. Because J2787 is a new technology/code and previously was billed under unspecified J codes, thorough documentation helps substantiate claims, minimize denials, and establish a basis for appeals if needed. Submit complete and accurate claims to reduce denials and avoid unnecessary resubmissions

## **Billing requirements** When billing HCPCS Code J2787, make sure the following points are met to avoid denials and ensure proper reimbursement: - **Correct coding**: Use J2787 to report riboflavin 5’-phosphate ophthalmic solution (up to 3 ml) when administered as part of corneal cross-linking. - **Procedure association**: Bill alongside the appropriate procedure code, such as CPT 0402T (corneal collagen cross-linking). - **Units**: Report units based on the amount administered. For a typical CXL procedure using 6ml, two units (each of up to 3ml) should be billed. If less than one full unit is used or wastage occurs, modifiers should be applied per payer rules. - **Drug wastage**: If a portion of a single-use vial is discarded, include JW (for discarded amount) or JZ (if no wastage) modifier as required by payers. - **Modifiers**: Apply required modifiers (if any) per payer rules, especially when multiple procedures are performed on the same day. - **NDC requirement**: Some payers may require the National Drug Code (NDC) on the claim to identify the exact drug supplied. - **Prior authorization**: Confirm if pre-approval is necessary, as corneal cross-linking often requires payer authorization before treatment. - **Reimbursement rates**: Reimbursement varies by payer, region, and contract. Confirm current fee schedule rates to set expectations and optimize billing accuracy.

## **Other relevant codes** - **CPT 0402T**: Collagen cross-linking of the cornea

Frequently asked questions

J2787 is used to report riboflavin 5’-phosphate ophthalmic solution, up to 3 mL, which is administered during corneal collagen cross-linking (CXL) procedures to treat progressive keratoconus and corneal ectasia.

Yes. J2787 is the permanent HCPCS code for Photrexa® (riboflavin ophthalmic solution) and Photrexa Viscous®. It should be reported separately from the CXL procedure (0402T).

Many commercial payers reimburse J2787, but coverage policies vary. It’s important to verify with each payer, as some may require prior authorization or consider CXL investigational.