Billing Code Overview

HCPCS Level II code J2777 describes the drug faricimab‑svoa, billed per 0.1 mg unit for injection. This code represents an ophthalmologic injectable therapy used in intravitreal treatment scenarios. The service type is drug administered by injection (ophthalmologic intravitreal therapy). Typical sites of service for claims including this drug are outpatient hospital settings or physician offices where intravitreal injections are performed.

Clinical Context

A patient with decreased vision and central blurry vision presents to a retina specialist in the outpatient clinic. The ophthalmologist documents macular edema secondary to a retinal vein occlusion or other retinal edema diagnosis and determines intravitreal anti-VEGF/anti-angiopoietin therapy is indicated. The patient is counseled about intravitreal injection risks and consents. In the clinic, the patient is prepared on the procedure chair, topical anesthesia and antisepsis are applied, and intravitreal injection of faricimab‑svoa (HCPCS Level II code J2777, billed per 0.1 mg unit) is administered under sterile technique. The injection administration is reported with the intravitreal injection CPT code 67028 with the appropriate laterality modifier RT or LT appended to 67028 to indicate the treated eye. The medication drug line uses HCPCS Level II code J2777 to report the faricimab‑svoa dose supplied.

Coding Specifications

• Modifier RT or LT: Used to indicate Right eye (RT) or Left eye (LT) laterality when billing the administration CPT code 67028. These laterality modifiers are appended to 67028 to identify which eye received the intravitreal injection. Do not append RT/LT to the HCPCS Level II code J2777 for the drug line unless payer-specific guidance requires laterality on the drug line.

• Associated provider taxonomies:

• Billing workflow notes:

• The injection administration is reported with 67028 (intravitreal injection of a pharmacologic agent). The drug supplied is reported separately with HCPCS Level II code J2777 for faricimab‑svoa, 0.1 mg units.

• Use the appropriate diagnosis code from the provided ICD-10 list that documents the retinal condition being treated on the claim.

Related Diagnoses

• H34.8110 — Central retinal vein occlusion, right eye

  • Clinical relevance: Central retinal vein occlusion can cause macular edema and vision loss; intravitreal faricimab‑svoa may be used to treat associated retinal edema.

• H34.8111 — Central retinal vein occlusion, left eye

  • Clinical relevance: Same clinical association for the left eye; directs laterality for procedure and billing.

• H34.8112 — Central retinal vein occlusion, bilateral

  • Clinical relevance: Bilateral involvement may require separate procedure entries for each eye and corresponding laterality documentation.

• H34.8120 — Branch retinal vein occlusion, right eye

  • Clinical relevance: Branch RVO can lead to localized macular edema treatable with intravitreal pharmacotherapy.

• H34.8121 — Branch retinal vein occlusion, left eye

  • Clinical relevance: Same as above for the left eye.

• H34.8122 — Branch retinal vein occlusion, bilateral

  • Clinical relevance: Bilateral branch RVO may require individualized treatment plans for each eye.

• H34.8130 — Venous tributary (branch) retinal vein occlusion, unspecified eye

  • Clinical relevance: Use when laterality is not specified; payer adjudication may require clarification.

• H34.8131 — Venous tributary (branch) retinal vein occlusion, right eye

  • Clinical relevance: Localizes the branch RVO to the right eye for treatment and billing.

• H34.8132 — Venous tributary (branch) retinal vein occlusion, left eye

  • Clinical relevance: Localizes the branch RVO to the left eye.

• H34.8310 — Retinal edema, right eye

  • Clinical relevance: Retinal edema is a direct indication for intravitreal anti‑edema therapy such as faricimab‑svoa.

• H34.8311 — Retinal edema, left eye

  • Clinical relevance: Same as above for the left eye.

• H34.8312 — Retinal edema, bilateral

  • Clinical relevance: Bilateral retinal edema may require separate entries per eye and documentation.

• H34.8320 — Local retinal edema, right eye

  • Clinical relevance: Focal retinal edema amenable to intravitreal therapy.

• H34.8321 — Local retinal edema, left eye

  • Clinical relevance: Focal retinal edema in left eye.

• H34.8322 — Local retinal edema, bilateral

  • Clinical relevance: Bilateral focal edema; document laterality per injection.

• H34.8330 — Edema of other parts of retina, right eye

  • Clinical relevance: Edema outside the macula may still be relevant to retinal disease management.

• H34.8331 — Edema of other parts of retina, left eye

  • Clinical relevance: As above for left eye.

• All listed ICD-10 codes should be reported on the claim to support medical necessity for intravitreal injection of faricimab‑svoa (J2777) and the administration code 67028.

Related Codes

• 67028 is commonly used together with HCPCS Level II code J2777 in the same encounter: 67028 for the procedure (with RT/LT) and J2777 for the medication. No alternative codes were provided in the input.

National mean rates for HCPCS Level II code J2777 show that BUCA (the aggregated commercial average) at $69.48 is substantially higher than Medicare, which has no national value provided in the input. Among the named commercial payers, Aetna's mean is notably elevated at $173.94, while Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare cluster near the mid-$30s.

Dispersion measured as the difference between the 75th and 25th percentiles varies across payers. Aetna shows a wide spread (P75–P25 = $10.17), indicating higher variability; Blue Cross Blue Shield and Cigna Health are among the tightest (BCBS P75–P25 = $3.00; Cigna P75–P25 = $0.00), while UnitedHealthcare and BUCA show moderate dispersion (UHC = $2.25; BUCA ≈ $2.83). The table and chart below present the full breakdown.