As finalized in the CY 2016 OPPS/ASC final rule with comment period (80 FR 70472), procurement/acquisition of corneal tissue will be paid separately only when it is used in corneal transplant procedures. Specifically, corneal tissue will be separately paid when used in procedures performed in the HOPD only when the corneal tissue is used in a corneal transplant procedure described by one of the following CPT codes: 65710 (Keratoplasty (corneal transplant); anterior lamellar); 65730 (Keratoplasty(corneal transplant); penetrating (except in aphakia or pseudophakia)); 65750 (Keratoplasty (corneal transplant); penetrating (in aphakia)); 65755 (Keratoplasty (corneal transplant); penetrating (in pseudophakia)); 65756 (Keratoplasty (corneal transplant); endothelial and any successor code or new code describing a new type of corneal transplant procedure that uses eye banked corneal tissue. HCPCS code V2785 (Processing, preserving and transporting corneal tissue) should only be reported when corneal tissue is used in a corneal transplant procedure; V2785 should not be reported in any other circumstances
9484.12 Effective January 1, 2016, contractors shall accept claims with HCPCS code V2785 (Processing, preserving and transporting corneal tissue) when corneal tissue is used in a corneal transplant procedure using the following CPT codes: 65710, 65730, 65750, 65755, 65756; endothelial and any successor code or new code describing a new type of corneal transplant procedure that uses eye banked corneal tissue.
NOTE: V2785 should not be reported in any other circumstances.
9484.12.1 Contractors shall deny claims with V2785 if submitted for services other than for corneal tissue used in a transplant procedure (CPT codes listed in BR 9484.12) and use the following messages:
B15: This service/procedure requires that a qualifying service/procedure be received and covered. The qualifying other service/procedure has not been received/adjudicated. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.M51:Missing/incomplete/invalid procedure code(s).
As finalized in the CY 2016 OPPS/ASC final rule with comment period (80 FR 70472), procurement/acquisition of corneal tissue will be paid separately only when it is used in corneal transplant procedures. Specifi cally, corneal tissue will be separately paid when used in procedures performed in the OPD only when the corneal tissue is used in a corneal transplant procedure described by one of the following CPT codes:
• 65710 (Keratoplasty (corneal transplant); anterior lamellar);
• 65730 (Keratoplasty (corneal transplant); penetrating (except in aphakia or pseudophakia));
• 65750 (Keratoplasty (corneal transplant); penetrating (in aphakia));
• 65755 (Keratoplasty (corneal transplant); penetrating (in pseudophakia));
• 65756 (Keratoplasty (corneal transplant); endothelial and any successor code or new code describing a new type of corneal transplant procedure that uses eye banked corneal tissue. HCPCS code V2785 (Processing, preserving, and transporting corneal tissue) should only be reported when corneal tissue is used in a corneal transplant procedure; V2785 should not be reported in any other circumstances.
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.
Billing Procedures
Ambulatory Surgical Center facility claims are submitted as an 837 Professional (837P) electronic transaction or on the CMS 1500 paper claim form. Claim completion instructions are described in the above Billing Information. The following instructions are specific to ASC facility services claims. Ambulatory Surgical Center information does not apply to other provider types.
Ambulatory Surgical Center claims should be submitted electronically. Electronic claims submission reduces billing expense and claims processing time. Information about electronic claims submission may be obtained from Electronic Data Interchange (EDI) Support at 1- 800-237-0757, Monday through Friday from 8:00 a.m. to 5:00 p.m. Mountain Time (MT). Procedure codes: ASCs identify services using HCPCS surgical procedure codes. During claim processing, the surgical code is linked to an appropriate ASC group for payment calculation.
Procedure codes: ASCs identify services using HCPCS surgical procedure codes. During
claim processing, the surgical code is linked to an appropriate ASC group for payment calculation. Implantable prosthetics: The following implantable prosthetic HCPCS codes are approved for billing by the
ASC or the surgeon as an 837P transaction or on the CMS 1500 paper claim form:
L8600 Implantable breast prosthesis, silicone or equal
L8603 Injectable bulking agent, collagen implant, urinary tract, 2.5 ml syringe, includes shipping and necessary supplies
L8606 Injectable bulking agent, synthetic implant, urinary tract, 1 ml syringe, includes shipping and necessary supplies
L8610 Ocular implant
L8612 Aqueous shunt
L8613 Ossicular implant
L8614 Cochlear device / system
L8619 Cochlear implant external speech processor, replacement
L8630 Metacarpophalangeal joint implant
L8631 Metacarpal phalangeal joint replacement, two or more pieces, metal (e.g., stainless steel or
cobalt chrome), ceramic-like material (e.g., pyrocarbon), for surgical implantation (all sizes, includes entire system)
L8641 Metatarsal joint implant
L8642 Hallux implant
L8658 Interphalangeal joint spacer, silicone or equal, each
L8659 Interphalangeal finger joint replacement, two or more pieces, metal (e.g., stainless steel or
cobalt chrome), ceramic-like material (e.g., pyrocarbon) for surgical implantation, any size
L8670 Vascular graft material, synthetic, implant
L8689 External recharging system for battery (internal) for use with implantable neurostimulator
V2785 Processing, preserving and transporting corneal tissue
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.
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 approvedASC.
- Shall deny payment for Q1003 if billed by an entity other than a Medicare-approved ASC.
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