Coding Update: Epithelium-on Corneal Cross-linking
Background
In October 2025, the FDA approved Epioxa™ HD / Epioxa™ for the treatment of keratoconus. This approval provides the opportunity for patients to receive Corneal Cross-Linking (CXL) therapy without removing the corneal epithelium, the outermost layer of the cornea.
Indication: Epioxa HD (riboflavin 5'-phosphate ophthalmic solution) 0.239% and Epioxa (riboflavin 5'-phosphate ophthalmic solution) 0.177% are indicated in epithelium-on corneal collagen cross-linking for the treatment of keratoconus in adults and pediatric patients aged 13 years and older, in conjunction with the O2n™ System and Boost Goggles®.
To assist providers in furnishing this service, ASCRS is providing updated billing guidance.
Drug code:
Prior to the assignment of a permanent drug code, Epioxa should be reported using code J3490, Unclassified drugs. For Hospital Outpatient Medicare claims, using C9399, Unclassified Drugs or Biologicals would be appropriate.
NDC Code:
Most payers will require the 11-digit NDC: 25357-0024-01 for Epioxa, while some may require the 10-digit NDC: 25357-024-01. EPIOXA HD and EPIOXA are co-packaged in an Epithelium-on Cross-linking Kit containing:
- One single-dose glass syringe containing 2 mL of EPIOXA HD 0.239% packaged in a foil pouch.
- One single-dose glass syringe containing 2 mL of EPIOXA 0.177% packaged in a foil pouch.
Modifiers:
Append the laterality modifier of -RT or -LT to code 0402T.
Append the modifier -JZ for no wastage as Epioxa is a single-use product and billed as 1 unit.
Procedure code:
The procedure is described by CPT® Code 0402T, Collagen cross-linking of cornea, including removal of the corneal epithelium, when performed, and intraoperative pachymetry, when performed. CPT Assistant Feb 16:12 notes “Do not report 0402T in conjunction with 65435, 69990, 76514.” CPT does not address the medication used with the procedure.
ICD 10 codes:
Choose the appropriate diagnosis code that includes laterality; Left, Right, or Bilateral code
H18.601 to H18.603 – Keratoconus, Unspecified (right eye, left eye, bilateral)
H18.611 to H18.613 – Keratoconus, Stable, (right eye, left eye, bilateral)
H18.621 to H18.623 – Keratoconus, Unstable, (right eye, left eye, bilateral)
Other considerations:
- Ensure your systems include J3490 for billing of Epioxa and that your charge master is updated to capture the full cost of the drug.
- Note: Epi-off Cross Linking utilized Photrexa which was billed using J2787 which is not appropriate for Epioxa.
- As with all procedures, you are encouraged to perform a pre-determination and a prior authorization using the correct codes (0402T, J3490 and drug description).
