Vabysmo (faricimab-svoa) — HCPCS J2777

Vabysmo vs. the rest of the anti-VEGF landscape HCPCS verified May 2026

The unit basis is the trap: J2777 is denominated in 0.1 mg increments, like Lucentis — not 1 mg like Eylea HD.

HCPCS J2777 — "Injection, faricimab-svoa, 0.1 mg" — uses a 0.1 mg unit basis. This is the same denomination as J2778 (ranibizumab) and different from J0177 (aflibercept HD, 1 mg per unit) and J0178 (aflibercept, 1 mg per unit). For Vabysmo, multiply the milligram dose by ten to get billable units.

The permanent J-code J2777 became effective October 1, 2022, replacing the temporary code C9097 that CMS used during the post-launch transition window in 2022. Any pre-October 2022 service dates may have used C9097; the J-code applies to all dates of service from October 1, 2022 forward.

Where Vabysmo sits in the class

Why Vabysmo's positioning matters for billing: it is the only bispecific in class and the only intravitreal anti-VEGF that acts on both the VEGF-A pathway and the angiopoietin-2 (Ang-2) pathway. The clinical claim — supported by the TENAYA / LUCERNE (wAMD), YOSEMITE / RHINE (DME), and BALATON / COMINO (RVO) trials — is that dual-pathway inhibition allows longer dosing intervals: ~62% of patients reached q16-week maintenance, the longest extended-interval data published for any intravitreal anti-VEGF. That is the principal exception argument when seeking authorization over a step-therapy denial.

Dosing per indication FDA label, BLA 761235

Source: DailyMed Vabysmo prescribing information. Three FDA-approved indications, all using the same 6 mg dose.

NDC reference FDA NDC Directory verified May 2026

Genentech labeler code 50242. Vabysmo is available as a single-dose vial (since 2022) and a single-dose prefilled syringe (FDA-approved July 4, 2024).

CPT 67028 & bilateral rules CPT verified May 2026

Intravitreal injections have unique laterality rules — per-eye billing, RT/LT preferred over modifier 50.

Bilateral same-day injections — RT/LT, not modifier 50

For bilateral Vabysmo injections on the same date of service, most payers require two separate line items:

• Line 1: 67028-RT, 1 unit, full fee
• Line 2: 67028-LT, 1 unit, full fee
• Line 3: J2777-RT, 60 units, full fee
• Line 4: J2777-LT, 60 units, full fee

Some commercial payers accept the alternative single-line format with modifier 50 on the procedure line:

• 67028-50, 1 unit, fee doubled

Per AAPC: "It is important to check with individual payers as some may require the procedure to be billed on two separate lines with -RT and -LT modifiers instead of using -50." Modifier 50 is not preferred for retina; RT/LT is the safer default.

Modifiers CMS verified May 2026

RT / LT — required for laterality

Append RT (right eye) or LT (left eye) to BOTH the J2777 drug line and the 67028 admin line. Without laterality, payer systems can't reconcile bilateral claims and will deny one or both lines. Modifier 50 is generally not preferred for retina coding.

JZ — required when no drug discarded

Effective July 1, 2023, CMS requires the JZ modifier on all single-dose container claims when no drug is discarded. The Vabysmo single-dose vial and prefilled syringe are sized exactly to a 0.05 mL / 6 mg injection, so wastage is essentially zero on a clean injection. JZ applies by default to nearly every Vabysmo claim — one full vial or PFS is administered per eye, with no partial-dose discard.

JW — rarely applies

Use JW only if at least one billable unit (0.1 mg) was actually wasted. Because Vabysmo is single-dose and sized exactly to the 0.05 mL injection volume, this is uncommon. If JW is appropriate (e.g., a partial dose was administered for clinical reasons and the remainder discarded), the wasted units are reported on a separate line from the administered units, with documentation in the medical record.

Modifier 25 — same-day E/M

Append modifier 25 to the E/M code when a significant, separately identifiable E/M service is performed on the same day as the injection. Routine pre-injection workup is bundled. New clinical concerns or treatment-decision visits (e.g., a switch evaluation from Eylea to Vabysmo, or a treat-and-extend interval change discussion) qualify; routine "see how the eye looks before the shot" does not.

NCCI bundling — OCT, fundus photo, B-scan, and 67028 NCCI verified May 2026

Ophthalmology-specific bundling that drives a large share of retina claim denials — the same warnings as Eylea, Eylea HD, and Lucentis.

CMS National Correct Coding Initiative (NCCI) bundles several diagnostic services with 67028 when performed same-day, same-eye:

Eye visit codes (92012, 92014) are NOT bundled with 67028, so they're often the better choice for the visit portion of a Vabysmo treat-and-extend encounter where interval decisions are being made.

ICD-10-CM diagnosis codes FY2026 verified May 2026

Same retinal codes as the Eylea family. Use the most specific code supported by the encounter documentation. Laterality character must match the RT/LT modifier on 67028.

Site of care & place of service Verified May 2026

Vabysmo is administered in-office or in an ASC. Home administration does not apply for intravitreal injections.

Intravitreal injections must be performed by an ophthalmologist or qualified retina specialist in a setting with sterile injection capability. Home administration is not a valid pathway for Vabysmo, so home-infusion HCPCS codes (S9329, S9379, 99601, G0089) do not apply. The only legitimate sites of care are physician office, ophthalmology-based ASC, and hospital outpatient.

Payer site-of-care steering

Both UnitedHealthcare and Aetna apply site-of-care utilization management to ophthalmology anti-VEGF injections, generally favoring office (POS 11) and ophth ASC (POS 24) over hospital outpatient (POS 19/22) due to higher facility fees. If your practice operates under a hospital's billing TIN, expect a payer challenge for hospital outpatient billing. This is especially pointed for Vabysmo given the per-dose drug cost (~$1,972 ASP+6%) layered on top of facility fees.

Claim form field mapping Genentech 2026 + Retina Today

CMS-1500 / 837P (physician office, ASC; POS 11/24).

Source: Retina Today — How to Create Clean Claims; Genentech Vabysmo Billing & Coding documentation.

Payer policy snapshot Reviewed May 2026

Vabysmo is heavily step-gated and listed non-preferred at most major commercial payers and many Medicare Advantage Part B step programs in 2026.

Why step therapy & non-preferred targeting here

Repackaged bevacizumab costs ~$50–100/dose vs. ~$1,972 for a 6 mg Vabysmo dose at Q2 2026 ASP+6%. Pavblu (aflibercept-ayyh) and other Eylea biosimilars trend 30–40% below reference Eylea. With a cheaper off-label agent and a meaningfully cheaper biosimilar pathway both available, payers steer Vabysmo to second- or third-line for cost containment despite its longer-interval clinical claim.

Exception pathway for Vabysmo as preferred therapy

• Documented prior bevacizumab failure (typically ≥3 doses, with OCT measurements and BCVA)
• Documented inadequate response on the payer's preferred branded agent (Eylea, Eylea HD, Pavblu, or other listed first-line branded)
• Contraindication or intolerance to bevacizumab and/or the preferred branded (e.g., prior thromboembolic event, hypersensitivity, intraocular inflammation history)
• Need for q16-week dosing — cite the TENAYA / LUCERNE / YOSEMITE / RHINE q16-week data in the appeal letter; Vabysmo's extended-interval profile is the principal differentiator vs. Pavblu/Eylea/Eylea HD

Medicare reimbursement CMS Q2 2026 (live)

Quarterly ASP from CMS Part B Drug Pricing File. Refreshes automatically each quarter. No biosimilar competition for Vabysmo through 2030+.

Coverage

No NCD specific to Vabysmo. The relevant MAC billing & coding article is A52451 ("Billing and Coding: Ranibizumab and biosimilars, Aflibercept, Aflibercept HD, Brolucizumab-dbll, Faricimab-svoa..."). All MACs cover J2777 for FDA-approved on-label indications (wAMD, DME, RVO ME). Bill with a specific H35.32xx, E1x.31x/E1x.33x, H34.81xx, or H34.83xx ICD-10 matched to the laterality on 67028.

Sequestration

Medicare ASP+6% is reduced by approximately 2% sequestration on the program payment side, effectively netting closer to ASP + 4.3% on the actual paid amount. The unit price shown above is the gross ASP+6% rate; net paid will be slightly lower.

Canonical code source: HCPCSdata J2777; CMS Part B Drug ASP Pricing File.

Patient assistance — Genentech Ophthalmology Co-pay (EyeOnCopay) Genentech verified May 2026

• Genentech Ophthalmology Co-pay Program (Vabysmo): eligible commercially-insured patients may pay as little as $0 copay per Vabysmo treatment
• Annual benefit cap: up to $15,000 per calendar year for the drug, plus up to $1,000 per calendar year for the administration (injection procedure)
• No income requirement for the copay program
• Excluded: patients enrolled in Medicare, Medicare Advantage, Medigap, Medicaid, VA, DoD, or TRICARE
• Enrollment: (855) 218-5307 or EyeOnCopay.com
• Genentech Patient Foundation: free Vabysmo for uninsured / underinsured patients meeting income requirements
• Independent foundations (federal patients): HealthWell Macular Degeneration Fund and Patient Access Network (PAN) provide support for Medicare patients — verify open funds quarterly, since macular degeneration funds open and close throughout the year

Common denials & how to fix them

Frequently asked questions

What is the HCPCS code for Vabysmo?

Vabysmo (faricimab-svoa) is billed under HCPCS J2777 — "Injection, faricimab-svoa, 0.1 mg." The unit basis is 0.1 mg per unit — NOT 1 mg per unit. Same denomination as Lucentis (J2778). The standard 6 mg Vabysmo dose is billed as 60 units of J2777. The permanent J-code became effective October 1, 2022, replacing temporary code C9097.

How many units do I bill for a 6 mg Vabysmo dose?

Sixty (60) units. J2777 is denominated in 0.1 mg units, and Vabysmo is dosed at 6 mg per intravitreal injection across all FDA-approved indications (wAMD, DME, RVO macular edema). Multiply the milligram dose by 10: 6 mg × 10 = 60 units. Bill 60 units of J2777 per eye treated. Bilateral same-day injections require two separate drug lines, 60 units each, with RT and LT modifiers.

What is the administration code for Vabysmo?

CPT 67028 — "Intravitreal injection of a pharmacologic agent (separate procedure)" — same as Eylea, Eylea HD, and Lucentis. Bill 67028 with an RT (right eye) or LT (left eye) modifier. For bilateral same-day injections, most payers require two separate line items with RT and LT, full fee on each — not modifier 50. RT/LT is the safer default for retina.

Is Vabysmo covered without step therapy?

Generally no. Vabysmo is non-preferred at most major commercial payers and many Medicare Advantage Part B step programs in 2026. UnitedHealthcare commercial requires bevacizumab (repackaged Avastin) first, then a preferred branded agent (Eylea, Eylea HD, or the Pavblu aflibercept biosimilar) before Vabysmo. Aetna lists Vabysmo as non-preferred (targeted) on its Medicare Part B drug list. Humana requires a documented inadequate response on bevacizumab (BCVA, OCT, or progression). The exception pathway is intolerance, contraindication, or documented inadequate response on the preferred agents.

What are the FDA-approved indications for Vabysmo?

Three indications under BLA 761235: neovascular (wet) age-related macular degeneration (FDA approval January 28, 2022); diabetic macular edema (January 2022); and macular edema following retinal vein occlusion (October 2023, S-003 supplement). All use the same 6 mg / 0.05 mL dose. The April 2026 label update for the RVO indication removed the original 6-month treatment cap, allowing individualized therapy beyond the initial six monthly doses based on response. Vabysmo carries no boxed warning.

What makes Vabysmo different from Eylea, Eylea HD, and Lucentis?

Vabysmo is the only bispecific intravitreal anti-VEGF — a humanized IgG1 antibody that simultaneously inhibits both VEGF-A AND angiopoietin-2 (Ang-2). Eylea, Eylea HD, and Lucentis are all anti-VEGF-A only. The clinical claim is that dual-pathway inhibition stabilizes vasculature better and supports longer dosing intervals: ~62% of patients in the registration trials reached q16-week maintenance dosing, the longest extended-interval data in class. There is no biosimilar for Vabysmo and patent protection extends through 2030+.

What is the Medicare reimbursement for J2777?

Medicare Part B reimburses J2777 at ASP + 6% per 0.1 mg unit. Q2 2026 ASP+6% is approximately $32.866 per unit, putting the standard 6 mg dose (60 units) at roughly $1,971.96 before sequestration. Sequestration (~2%) reduces actual paid to roughly ASP + 4.3%. ASP is updated quarterly by CMS via the Part B Drug Pricing File.

Are 67028 and OCT (92133/92134) bundled by NCCI for Vabysmo claims?

Yes. NCCI bundles 67028 with 92133/92134 (OCT scans), 92250 (fundus photography), and 76512 (B-scan ultrasound) when performed same-day, same-eye. To unbundle, append modifier XU, 59, or 25 (E/M) to the bundled code with documented separate medical necessity (e.g., the OCT informed a treatment-extension or switch decision distinct from the injection itself). Eye visit codes 92012/92014 are NOT bundled with 67028 by NCCI.

Does Vabysmo come in a prefilled syringe?

Yes. The original 2022 launch was a single-dose vial only (NDC 50242-096-01, 6 mg / 0.05 mL). The single-dose prefilled syringe was FDA-approved July 4, 2024 (NDC family 50242-098). Both presentations are 120 mg/mL, single-dose, sized to the 0.05 mL injection volume — there is no clinical wastage on either, so JZ applies to both. Verify the exact 11-digit NDC on the package label at billing time.

Source documents

1. DailyMed — Vabysmo (faricimab-svoa) Prescribing Information
   FDA-approved label, BLA 761235; April 2026 RVO update
2. HCPCSdata — J2777 "Injection, faricimab-svoa, 0.1 mg"
   Canonical code descriptor and unit basis
3. AAPC — HCPCS J2777 (Vabysmo, faricimab-svoa)
4. FDA — Vabysmo approval announcement (January 28, 2022)
   Original wAMD + DME approval; bispecific anti-VEGF / anti-Ang-2 mechanism
5. Genentech — Vabysmo prefilled syringe FDA approval (July 4, 2024)
   Single-dose PFS approval; NDC 50242-098 family
6. CMS MCD Article A52451 — Ranibizumab and biosimilars, Aflibercept, Aflibercept HD, Brolucizumab-dbll, Faricimab-svoa billing & coding
   MAC billing/coding article covering J2777 and the broader intravitreal anti-VEGF class
7. CMS — Medicare Part B Drug ASP Pricing File
   Q2 2026 quarterly file, effective April 1 – June 30, 2026
8. UnitedHealthcare — Ophthalmologic VEGF Inhibitors policy
   Step-therapy criteria; bevacizumab-then-preferred-branded pathway; Vabysmo non-preferred
9. Aetna CPB 0701 — VEGF Inhibitors for Ocular Indications
10. Aetna 2026 Medicare Part B Step Therapy Drug List
    Vabysmo listed as non-preferred (targeted) on Medicare Part B step program
11. Humana — Medical coverage policies (Vabysmo / faricimab)
    Documented inadequate response on bevacizumab requirement
12. Genentech EyeOnCopay — Vabysmo Co-pay Program
    $0 copay; up to $15,000/year drug + $1,000/year admin; commercial-insured only
13. Genentech — Vabysmo HCP product page (billing & coding resources)
14. Retina Today — How to Create Clean Claims
    CMS-1500 field-by-field claim guidance for retina
15. Retina Today — The Effect of Bilateral Rules on Retina Coding
    RT/LT vs modifier 50 guidance
16. AAPC — CPT 67028
    Code descriptor and bilateral billing notes
17. CMS NCCI — National Correct Coding Initiative edit tables
    67028 + 92133/92134/92250/76512 bundling edits
18. HealthWell Foundation — Macular Degeneration Fund
    Independent foundation support for federally-insured Vabysmo patients

About this page

We maintain this page as a living reference. Medicare ASP pricing is bound to our underlying CareCost data layer and refreshes automatically when CMS publishes new quarterly files. Coding and policy content is reviewed at least quarterly and updated whenever a source document changes.

Found an error? Email hello@carecostestimate.com.

Refresh cadence

Reviewer

Change log

• May 2, 2026 — Initial publication. ASP data: Q2 2026. FDA label: BLA 761235 (three indications: wAMD Jan 2022, DME Jan 2022, RVO ME Oct 2023; April 2026 RVO label update removed 6-month treatment cap). Permanent J-code J2777 effective Oct 1, 2022 (replaced temp C9097). Single-dose vial NDC 50242-096-01; single-dose PFS NDC family 50242-098 (FDA-approved July 4, 2024). Payer policies: UHC Ophth VEGF Inhibitors, Aetna CPB 0701, Aetna 2026 Medicare Part B step list, Humana medical coverage policy. Cross-links added to Eylea, Eylea HD, and Lucentis.

Methodology

Every claim on this page is sourced inline. Pricing reflects the current CMS Part B Drug ASP Pricing File. Payer policies are read directly from each payer's published medical policy documents and Medicare Advantage Part B step lists. We do not paraphrase from billing-software vendor blogs. When manufacturer guidance and payer policy conflict (as happens with bilateral injection coding, step-therapy preferred-agent ordering, and post-month-6 RVO continuation), we surface the conflict rather than picking a side.