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Working with OMIDRIA
Dedicated Support
Discover how to order OMIDRIA
OMIDRIA has separate payment status in ASCs and HOPDs for 100% of fee-for service Medicare patients*
OMIDRIA has a unique billing code: J1097†
Phenylephrine 10.16 mg/mL and ketorolac 2.88 mg/mL ophthalmic irrigation solution, 1 mL. 1
OMIDRIA is reimbursed per mL; therefore, providers should always use 1 mL as the billing unit and bill for 4 units when a vial of OMIDRIA is utilized/used.
†ASCs use this unique permanent HCPCS code to bill CMS and other payers for separate payment. HOPDs use this unique HCPCS code to bill commercial payers and Med Advantage.
ASC=ambulatory surgical center; HCPCS=Healthcare Common Procedure Coding System; HOPD=hospital outpatient department.
*OMIDIRA qualifies for separate payment across both ASC and HOPD settings as it fulfills the requirements established in the non-opioid as a surgical supply provision by CMS
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, underinsured, or uninsured patients (based on financial need and eligibility requirements)
Field Reimbursement Managers to help you navigate through the reimbursement pathway
Schedule an in-service with your OMIDRIA Field Reimbursement Manager by emailing omidriafrms@rayner.com or by calling 1-844-RAYNER1 (1-844-729-6371).
OMIDRIA is on the VA National Formulary with no PA required.
‡ Based on your Medicare or commercial plan selection, your coverage may require a copay for OMIDRIA.
PA=prior authorization; VA=United States Department of Veterans Affairs.
Explore and access resources by area:
Reimbursement Assistance
Ordering and Using OMIDRIA
Clinical Data
Patient Education
Payment Schedules
Automatic Hardships
Reimbursement Guide
Review this important office guide for coding and billing assistance, including sample claim forms
Instructions for We Pay The Difference Enrollment Form
Review this guide for an overview on how to complete the enrollment process for each commercially insured We Pay the Difference patient
We Pay the Difference Enrollment Form
Enroll commercially insured patients in the We Pay the Difference reimbursement program
OMIDRIAssure Patient Certification Form
Determine patient eligibility for the Equal Access patient assistance program
Letter of Medical Necessity
Use this template letter to communicate with payers; this letter can be customized to establish the medical reason that OMIDRIA was used
Access OMIDRIAssure Online Portal.
For more information, please contact an OMIDRIA Field Reimbursement Manager.
ASC=ambulatory surgery center; HOPD=hospital outpatient department.
References:
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Centers for Medicare & Medicaid Services. HCPCS January 2024 Index. Accessed January 28th , 2025 https://www.cms.gov/medicare/payment/prospective-payment-systems/hospital-outpatient-pps/quarterly-addenda-updates
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.
Important Safety Information
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.
Please see the Full Prescribing Information for OMIDRIA.
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.
Important Safety Information
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.
Please see the Full Prescribing Information for OMIDRIA.
You are encouraged to report Suspected Adverse Reactions to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.