CTAK Reimbursement
CorneaGen offers free CTAK reimbursement and medical claims assistance to help guide you in billing to your local Medicare carrier and other commercial insurance carriers. Our internal resources in conjunction with 3rd party health care consultants, will help with coding, coverage, and reimbursement inquiries.
Procedure Overview
Corneal Tissue Addition Keratoplasty (CTAK) is the latest advancement in keratoconus treatment, offering enhanced accuracy and precision for both patients and surgeons. This innovative procedure utilizes a CTAK inlay designed to optimize corneal flattening, improve visual acuity, and increase corneal thickness. Unlike full-thickness corneal transplantation, CTAK preserves native corneal tissue by implanting a customized, gamma-irradiated corneal inlay into a laser-created corneal pocket.
This web guide provides a detailed breakdown of billing, reimbursement, and common payer considerations for CTAK, including procedure, tissue acquisition, laser usage, and facility-specific billing nuances.
CTAK Reimbursement
Primary Procedure & Tissue Codes
| Code | Description |
|---|---|
| CCPT® 65710 | Anterior Lamellar Keratoplasty surgical procedure |
| HCPCS V2785 | Processing, preserving, and transporting corneal tissue |
Modifiers to Consider
| Modifier | Description | Usage |
|---|---|---|
| LT or RT | Left Side OR Right Side Procedure | Modifier(s) used for determination of which eye is receiving the procedure |
| -22 | Increased Procedural Services |
Used when work required for the procedure is substantially greater than typically required. This can be related to procedural or time-added complexities |
| -23 | Non-Standard Anesthesia | Used when anesthesia is used outside of the standard local anesthesia practices for the pro |
| -24 | Patient Evaluation for Unrelated Procedure |
Used when a physician or other qualified healthcare professional provides evaluation services unrelated to the procedure during post-op period |
| -50 | Bilateral Procedure | Used when the procedure occurs for both eyes in the same surgical session |
| -51 | Multiple Procedures | Used when multiple procedures other than anterior lamellar keratoplasty are performed in the same surgical session |
| -59 | Distinct Procedural Service |
Used when indicating a procedure or service was performed that is independent of other services on the same day separate from the procedure |
| -76 | Repeat Procedure, Same Physician |
Used when the procedure needs to be repeated by the same physician |
| -78 | Unplanned Return to Procedure Room |
Used in circumstances where the patient has returned to the OR for procedures related to the initial procedure during the recovery period |
| -79 | Unrelated Procedure by Same Physician Post-Op |
Used in circumstances where an unrelated procedure is performed during the post-operative period |
Medicare Reimbursement for CTAK
Coverage Considerations
CTAK is eligible for Medicare reimbursement when deemed medically necessary.
Separate reimbursement for corneal tissue (V2785) is allowed based on the actual cost from the eye bank, which must be supported by an invoice.
Prior authorization is generally not required for Medicare, but proper documentation of medical necessity is essential.
Medicare Payment by Facility Type
| Setting | Billing Considerations | Reimbursement Details |
|---|---|---|
| Hospital Outpatient (HOPD) | Billed under Ambulatory Payment Classification (APC) |
Medicare reimburses separately for corneal tissue (HCPCS code V2785). Medicare Status Indicator “F” ensures corneal tissue is paid at reasonable cost outside the Outpatient Prospective Payment System (OPPS) |
| Ambulatory Surgery Center (ASC) |
CPT® 65710 reimbursed under ASC payment system |
V2785 is separately payable, with an eye bank invoice required. Medicare Administrative Contractors (MACs) have specific billing policies that mandate the separate reporting of V2785 for corneal tissue claims, with regional variations depending on the MAC jurisdiction. |
| Physician’s Office | Medicare generally does not reimburse facility fees |
Requires payer-specific approval. |
Required Documentation for Medicare
- Surgeon’s operative report
- Eye bank invoice (for V2785 reimbursement)
- Medical necessity justification (keratoconus diagnosis, previous failed treatments, etc.)
CorneaGen has an extensive library of pre-authorization and appeal documents available for use to assist you with your insurance payer discussions. You can access those letters at CorneaGen.com/
Reimbursement/CTAK or reach out to your Surgical Product Specialist for additional information
Commercial Payer Reimbursement for CTAK
Coverage Considerations
- Coverage varies widely by insurer. Some commercial plans consider CTAK investigational, making prior authorization critical.
- Some payers bundle corneal tissue costs into procedural payments, meaning HCPCS V2785 may not be separately reimbursed.
Medicare Payment by Facility Type
| Setting | Billing Considerations | Reimbursement Details |
|---|---|---|
| Hospital Outpatient (HOPD) | CPT® 65710 and HCPCS V2785 billed separately |
Some plans bundle corneal tissue into procedural payment. |
| Ambulatory Surgery Center (ASC) |
ASC facility fee may be reimbursed separately | Prior authorization required for both procedure and tissue. |
| Physician’s Office | If approved, procedure fee may be covered | Facility fee is not covered, limiting financial viability in-office |
Required Documentation for Commercial Payers
- Prior authorization confirmation
- Medical necessity justification
- Invoice for corneal tissue (if V2785 is separately reimbursed)
Currently, no specific CPT® or HCPCS code exists for laser click fees in keratoplasty procedures.
- Medicare & Most Commercial Payers: Laser usage is generally bundled into procedural reimbursement and not separately paid.
- Some Commercial Payers: May allow separate reimbursement if justified with medical necessity documentation.
Exceptions
Some regional commercial insurance providers outsource bill processing of corneal tissue to a third-party health plan administrator. Those administrators may require different coding than V2785. A list of
commercial insurance companies known to use a third-party administrator is below. For those listed in the regions below, it is encouraged to review your insurance contract for billing procedures or contact CorneaGen at Contracts@CorneaGen.com so we can help you connect with the appropriate personnel at the Administrator’s office.
- Aetna – Nationwide
- Anthem – CA, NV, GA, OH, NH, CT, IN
- BCBS – FL, NC
- CBC – PA
Key Considerations
- Verify insurance coverage and benefits prior to performing CTAK.
- Submit corneal tissue invoices (Medicare and nearly all commercial payers require this).
- Submit corneal tissue invoices (Medicare and nearly all commercial payers require this).
- Be prepared to negotiate reimbursement rates with commercial payers.
- Understand prior authorization processes and documentation requirements for both Medicare and commercial payers.
- Include the eye bank invoice with any payment request submissions to your insurance payer.
- For CPT 65710, applicable modifiers must be used correctly to avoid claim denials.
Disclaimer
Coverage and reimbursement policies may change, and private payer policies may differ from Medicare. Always verify details with payers before submitting claims. For reimbursement support, contact Contracts@CorneaGen.com.
We Offer Reimbursement Consultation Services
If you need assistance with reimbursement of corneal tissue, CorneaGen is pleased to provide its customers with reimbursement and medical claims assistance to help guide you in billing corneal tissue to your local Medicare carrier and other commercial insurance carriers.
You can receive reimbursement consultation services free of charge, through NMD HealthCare consulting. NMD is fully prepared to receive and respond to all of CorneaGen’s customers’ coding, coverage and reimbursement inquires.
Please reach out to your CorneaGen Surgical Product specialist so that they can connect you with a NMD representative. For more information on NMD, visit their website.