Corneal Tissue Claims

Many ambulatory surgery centers (ASCs) frequently have difficulty securing reimbursement for corneal tissue (V2785). Medicare administrative contractors generally want a copy of the invoice from the Eye Bank yet the MACs do not make it simple or straightforward to submit that invoice. The turnaround time on claims is lengthy.

National Government Services (NGS), Medicare contractor for New York, Connecticut, Indiana, and Kentucky plans to change the current process in an effort to expedite claims processing. As of July 1, 2009, ASCs in their jurisdiction no longer need file an invoice with the claim. They instruct ASCs to:

  • Include the name of the eye bank in box 19 (electronic notepad)
  • Right (RT) and left (LT) modifiers should be appended as appropriate
  • Modifier KX should also be added to attest to the amount on the claim matching the total amount on the invoice (this amount includes shipping)
  • Copies of invoices should remain in the patient’s medical record

This instruction is specific to NGS. Check you contractor websites to determine if a similar instruction exists for your locale.

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