Corneal Tissue Reimbursement Update

The 2015 CPT Manual introduced new and revised codes associated with glaucoma shunts.  Historically, surgeons might place a graft over the shunt and bill for the additional procedure with CPT 67255, scleral reinforcement with graft.  The surgeon and the facility would file claims for both procedures and be reimbursed for both.  Reimbursement for the graft was included in the facility reimbursement for the procedure.

New CPT codes published in January are as follows:

• 66179  Aqueous shunt to extraocular equatorial plate reservoir, external approach; without graft  (new)
• 66180              with graft (revised)
  • (Do not report 66180 in conjunction with 67255)

• 66184  Revision of aqueous shunt to extraocular equatorial plate reservoir; without graft  (new)
• 66185              with graft (revised)
  • (Do not report 66185 in conjunction with 67255)

Surgeons and facilities are no longer permitted to submit CPT code 67255 for the placement of the graft as it is differentiated in the procedure for insertion of the shunt, as either with graft or without graft.

HOPDs and ASCs are concerned about their ability to recoup the cost of the graft with this coding change.  In Transmittal R3214CP, CMS indicates that they will reimburse ASCs separately for corneal tissue when it is used with CPT codes 66180 and 66185.  The corneal tissue is submitted as V2785 and reimbursed based on invoice cost.  In addition, the patch graft must be corneal tissue and not sclera, pericardium, amniotic membrane, or other type of tissue. 

The Medicare Claims Processing Manual, Chapter 4, §200.1, provides HOPDs with instructions for reimbursement of V2785 which is not part of the Outpatient Prospective Payment System (OPPS).  The instruction can be found at:  http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c04.pdf. 

The CMS transmittal can be found at:  http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3214CP.pdf  (see Item 5, page 3-4).