Cornea Transplant Background
At CorneaGen, we are advocates for all patients suffering from corneal related sight issues including disease or trauma related blindness.
Advanced Cornea Care
To ensure patients have access to a high standard of care, CorneaGen analyzed trends in private payer insurance claims data and found that often, tissue is not being reimbursed at appropriate levels which can lead hospitals and surgeons to conclude that corneal transplant procedures are not cost effective, distorting the total costs of corneal graft procedures and causing them to limit corneal surgeries.
Corneal transplantations are truly life altering procedures that profoundly affect every day visual function and quality of life. We are committed to removing systemic barriers that limit patients’ access to care and surgeons’ ability to provide the best corneal treatments to their patients.
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Eye Bank Information
Helpful insight and background information.
Medical Journal Articles
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Patient-Reported Outcomes After Corneal Transplantation - Oct 2021
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High-risk Corneal Transplantation: Recent Developments and Future Possibilities - Dec 2019
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Corneal Transplantation in the Modern Era - Jan 2019
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Deep Anterior Lamellar Keratoplasty as an Alternative to Penetrating Keratoplasty - January 2011.
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Relevant Commercial Plan Examples
Cigna Medical Coverage Policy: Corneal Remodeling for Refractive ErrorsDownload
Cigna’s only policy. Located on page 20 is the transplant CPT codes. Please note that HCPCS code (V2785) for tissue is not mentioned. The next review is scheduled for October 15, 2023.
Aetna Clinal Policy Bulletin: Corneal RemodelingDownload
Refer to pages 17 – 18 where V2785 remains billable and separately reimbursed. The next review is scheduled for January 9, 2025.
EmblemHealth (Commercial, Medicare & Medicaid plans) Download
Refer to page 14 where it states in part, “….corneal tissue (HCPCS code V2785) is not payable when billed without a corneal transplant procedure CPT code….”
Medicaid
MAC (Palmetto GBA) Policy: Claim Submission for HPCPS Code V2785Download
This Medicare payment policy provides guidance on billing and reporting guidelines to receive separate payment for corneal tissue (V2785) based on invoice cost.
MAC (Novitas) Policy: Corneal Tissue Procurement/AcquisitionDownload
This Medicare payment policy is for use in both Hospital outpatient departments [HOPDs] and Ambulatory Surgery Centers [ASCs]. It provides billing instructions and claim form submission procedures to ensure appropriate payment for corneal tissue (V2785) which is based on acquisition cost or invoice.
EmblemHealth (Commercial, Medicare & Medicaid plans)Download
Refer to page 14 where it states in part, “….corneal tissue (HCPCS code V2785) is not payable when billed without a corneal transplant procedure CPT code….”
Regulatory Information
American Association of Tissue Banks (AATB) Regulatory BulletinDownload
AATB Regulatory Bulletin with 2nd paragraph description how the of National Organ and Tissue Transplant (NOTA) law allows for tissue reimbursement.