Codes & NDC
| HCPCS | J2777 — "Inj, faricimab-svoa, 0.1 mg" (permanent, eff. 10/1/2022; replaced temp C9097) |
|---|
| NDC (vial) | 50242-096-01 — 6 mg / 0.05 mL SDV (120 mg/mL) |
|---|
| NDC (PFS) | 50242-098-xx family — single-dose PFS (FDA-approved Jul 4, 2024). Verify exact 11-digit NDC at billing. |
|---|
| Vial | 6 mg in 0.05 mL of 120 mg/mL solution; 2–8°C; 24 hr RT before use |
|---|
| Mechanism | First bispecific: inhibits VEGF-A AND angiopoietin-2 (Ang-2) |
|---|
| Benefit | Medical (provider buy-and-bill); not specialty pharmacy |
|---|
Unit math — multiply mg × 10
| Dose | Units of J2777 |
|---|
| 6 mg (all indications) | 60 units |
Top biller error: billing 6 units (or 1 unit) of J2777 for a 6 mg dose. J2777 is denominated in 0.1 mg, like Lucentis — NOT 1 mg like Eylea HD. Always 60 units per 6 mg dose.
Dosing per indication
| Indication | Loading | Maintenance |
|---|
| wAMD | 6 mg q4wk × 4 | q8–q16wk personalized |
| DME | 6 mg q4wk × 4–6 | q8–q16wk personalized |
| RVO ME | 6 mg q4wk × 6 | (Apr 2026 label removed prior 6-mo cap) |
Trial data: ~62% wAMD/DME pts reach q16wk — the key extended-interval claim.
Bilateral billing (RT/LT, not -50)
Most payers require two separate lines for bilateral same-day:
- Line 1:
67028-RT + J2777-RT 60 units
- Line 2:
67028-LT + J2777-LT 60 units
Some commercial payers accept 67028-50 (1 unit, fee × 2). Verify per payer.
Modifiers
| Mod | When |
|---|
RT / LT | Required on both J2777 and 67028 lines |
E1–E4 | Some payers require eyelid quadrant |
JZ | Required — full 6 mg SDV/PFS, no waste |
JW | Not applicable (sized to dose) |
25 | On E/M when separately identifiable |
XU / 59 | To unbundle OCT/fundus photo from 67028 |
ICD-10 (most common)
| Code | For |
|---|
H35.32 / H35.3210–3293 | Wet AMD (laterality + stage) |
E11.311 | T2DM with unspec DR with macular edema |
E11.321 / E11.331 / E11.339 | T2DM mild / moderate / severe NPDR with ME |
E10.311 / E10.321 / E10.331 / E10.339 | T1DM equivalents (DME) |
H34.81 / H34.811/812/819 | CRVO with macular edema (RT/LT/unspec) |
H34.83 / H34.831/832/839 | BRVO with macular edema |
H35.81 | Retinal edema (adjunct only) |
Match laterality. ICD-10 5th-char laterality must match RT/LT modifier.
Payer requirements (May 2026)
| Payer | PA | Step / Status |
|---|
| UnitedHealthcare commercial | Yes | Yes — bevacizumab first, then preferred branded (Eylea/HD/Pavblu); Vabysmo non-preferred |
| Aetna Medicare Part B | Yes | Non-preferred (targeted) on MA Part B step program |
| Aetna commercial | Yes | Bevacizumab + preferred branded trial often required |
| Humana | Yes | Yes — documented inadequate response on bevacizumab (BCVA/OCT) |
| BCBS (most plans) | Yes | Bevacizumab trial; some add preferred branded trial |
Two-step pattern is now common. Best exception lever: q16wk extended-interval data (~62% trial pts) that Pavblu/Eylea cannot match.
Medicare reimbursement (Q2 2026)
| Field | Value |
|---|
| ASP + 6% | $32.866 / 0.1 mg unit (effective 4/1 – 6/30/2026) |
| 6 mg dose (60 units) | $1,971.96 |
| After ~2% sequestration | ~$1,932 (~ASP+4.3% actual paid) |
| vs. Avastin (off-label) | ~$50–100/dose (cost driver for step therapy) |
Site of care
| Setting | POS | Form |
|---|
| Physician / retina office | 11 | CMS-1500 / 837P |
| Ophthalmology ASC | 24 | CMS-1500 / 837P |
| Hospital outpatient | 19/22 | UB-04 / 837I (UHC, Aetna disfavor) |
Home admin not applicable. Intravitreal must be in-office or ASC.
Patient assistance — Genentech Access Solutions
- Vabysmo OPEN / EyeOnCopay: as low as $0/treatment for commercial patients
- Annual cap: up to $15,000/yr drug + $1,000/yr admin; no income requirement
- Excluded: Medicare, Medicare Advantage, Medigap, Medicaid, VA, DoD, TRICARE
- Enrollment: (855) 218-5307 · eyeoncopay.com
- Genentech Patient Foundation: free Vabysmo for uninsured/underinsured
- Medicare patients: verify HealthWell Macular Degeneration Fund & PAN quarterly
Warnings & Precautions
- Endophthalmitis & retinal detachments from intravitreal injection — aseptic technique mandatory
- Increased IOP within 60 min of injection — monitor IOP and optic nerve perfusion
- Retinal vasculitis ± retinal vascular occlusion — post-marketing reports (often immune-mediated; severe vision loss). Counsel patients on new vision changes.
- Arterial thromboembolic events (stroke, MI, vascular death)
Different code for same molecule via port: Susvimo (ranibizumab port delivery) = J2779 — not Vabysmo. Don't confuse with bispecific intravitreal Vabysmo (J2777).