Non-opioid OMIDRIA qualifies for separate payment by the Centers for Medicare & Medicaid Services (CMS) when used in ambulatory surgery centers (ASCs)1
OMIDRIA has a unique billing code: J1097 Phenylephrine 10.16 mg/mL and ketorolac 2.88 mg/mL ophthalmic irrigation solution, 1 mL3
OMIDRIA is reimbursed per mL; therefore, providers should always use 1 mL as the billing unit and bill for 4 units when a full vial of OMIDRIA is utilized.
The OMIDRIAssure® program offers patients options to assist with the cost of OMIDRIA:
We Pay the Difference patient reimbursement program for commercially insured patients
Equal Access patient assistance program for government-insured or uninsured patients (based on financial need)
Dedicated access to comprehensive reimbursement programs for your cataract procedures:
Field Reimbursement Managers to help you navigate through the reimbursement pathway
Schedule an in-service with your OMIDRIA Field Reimbursement Manager by contacting your OMIDRIA Sales Representative or call 1-877-OMIDRIA(1-877-664-3742) 9 AM-5 PM ET, Monday-Friday.
REFERENCES:1. US Department of Health and Human Services. Medicare program: hospital outpatient prospective payment and ambulatory surgical center payment systems and quality reporting programs; price transparency of hospital standard charges; radiation oncology model; request for information on rural emergency hospitals. Fed Regist. 2021;86(147):42018-42360. 2. Centers for Medicare & Medicaid Services. ASC Payment Rates – Addenda. Updated September 23, 2021. Accessed September 29, 2021. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/11_Addenda_Updates 3. Centers for Medicare & Medicaid Services. HCPCS October 2021 Index. Accessed September 16, 2021. https://www.cms.gov/medicare/coding/hcpcsreleasecodesets/hcpcs-quarterly-update.html
OMIDRIA must be added to irrigating solution prior to intraocular use.
OMIDRIA is contraindicated in patients with a known hypersensitivity to any of its ingredients.
Systemic exposure to phenylephrine may cause elevations in blood pressure.
Use OMIDRIA with caution in individuals who have previously exhibited sensitivities to acetylsalicylic acid, phenylacetic acid derivatives, and other nonsteroidal anti-inflammatory drugs (NSAIDs), or have a past medical history of asthma.
The most commonly reported adverse reactions at ≥ 2% are eye irritation, posterior capsule opacification, increased intraocular pressure, and anterior chamber inflammation.
You are encouraged to report Suspected Adverse Reactions to the FDA. Visit
www.fda.gov/medwatch
, or call 1-800-FDA-1088.
Indications and Usage
OMIDRIA® is added to ophthalmic irrigating solution used during cataract surgery or intraocular lens replacement and is indicated for maintaining pupil size by preventing intraoperative miosis and reducing postoperative ocular pain.
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