Bundled CPT codes

Rebundling of CPT Codes

The national correct coding initiative (NCCI) rebundling instructions apply to processing claims from ASC facilities. In general, if an ASC bills a CPT code that is considered to be part of another more comprehensive code that is also billed for the same beneficiary on the same date of service, only the more comprehensive code is covered, provided that code is on the list of ASC approved codes.

Payment for Corneal Tissue

For dates of service prior to January 1, 2008, payment for corneal tissue used in an approved ASC procedure is separately payable to either the ASC or surgeon. Effective January 1, 2008, payment for corneal tissue is separately payable only to the ASC. Procedure code V2785 (processing, preserving, and transporting corneal tissue) must be used to report this service. A copy of the invoice from the eye bank which provided the corneal tissue is required.
Note: Providers must provide the invoice upon request.

Payment for Intraocular Lens (IOL)
The procedures that include insertion of an IOL are CPT codes 66982,66983, 66984, 66985, and 66986. Prior to January 1, 2008, payment for facility services furnished by an ASC for IOL insertion during or subsequent to cataract surgery includes an allowance for the lens. The ASC payment system logic that excluded $150 for IOLs for purposes of the multiple surgery reduction in cases of cataract surgery no longer applies. Beginning January 1, 2008, the Medicare payment for the IOL is included in the Medicare ASC payment for the associated surgical procedure. ASCs should not report separate charges for conventional IOLs because their payment is included in the Medicare payment for the associated surgical procedure.

Payment for New Technology Intraocular Lenses (NTIOLs)

Effective for dates of service on and after February 27, 2006, through February 26, 2011, Medicare will pay an additional $50 for Category 3 NTIOLs. HCPCS code Q1003 has been created to bill for the additional $50. Q1003 shall be billed on the same claim as the surgical insertion procedure.
Any subsequent IOLs recognized by CMS as having the same characteristics as the first IOL recognized by CMS for a payment adjustment (those of reduced spherical aberration-Category 3) will receive the same adjustment for the remainder of the 5-year period established by the first recognized IOL. Contractors and providers will be aware that HCPCS Q1003, along with one of the approved procedures codes (66982, 66983, 66984, 66985, and 66986) are to be used on all Category 3 NTIOL claims associated with reduced spherical aberration from February 27, 2006, through February 26, 2011. The list of Category 3 NTIOLs is available on the CMS Web site at:
http://www.cms.hhs.gov/ASCPayment/08_NTIOLs.asp#TopOfPage.

Medicare contractors:
• Shall return as unprocessable any claims for NTIOLs containing Q1003 alone or with a code other than one of the above listed procedure codes.
• Shall deny payment for Q1003 if services are furnished in a facility other than a Medicare-approved ASC.
• Shall deny payment for Q1003 if billed by an entity other than a Medicare-approved ASC.