Tissue Reimbursement

How to Bill Most Insurance Payers

Eye banks are not Medicare providers and their donor tissue services are to be billed as a pass through paid at total invoice cost.

Hospitals and ambulatory surgical centers (ASCs) report Healthcare Common Procedure Coding System (HCPCS) code V2785 when billing for the costs of acquiring corneal tissue. This code includes tissue processing, laboratory tests for infectious disease, and transportation.

1. For hospitals: To receive cost-based reimbursement, submit charges for corneal tissue
   acquisition using HCPCS code V2785 which has a Medicare Status Indicator “F” meaning that corneal tissue is not paid under OPPS but paid at reasonable cost.
2. For ASCs: V2785 may be billed separately or as an add-on to ASC-allowable surgical procedure codes for keratoplasty. ASCs must submit an electronic or paper copy of the eye bank invoice along with the claims form. Please be aware that there are many MACs with policies in place that specifically require billing V2785 for claims reporting of corneal tissue.
3. Please be aware that additional facility information may be required by Medicaid or Private Payers.
4. For commercial payers, CorneaGen suggests Prior Authorization of benefits for any new facility or first-time insurer/payer to identify any reimbursement concerns prior to procedure.To perform a PA, several pieces of provider/practice/facility information are required such as copies of patient’s insurance card (front and back).Also, most if not all commercial payers have their own Pre-Authorization letter that is required to be completed by the customer for Pre-Authorization. CorneaGen recommends reaching out to the individual payer to request their specific Pre-Authorization letter.
5. We offer a proactive claim review in advance of the claim being submitted to the payer to ensure all required data is completed and included in the fields/ form locators, filled out properly/correctly on both/either the 1450 (HOPD) and/or the 1500 (ASC).

If you are experiencing any reimbursement issues or payer gaps, please reach out directly to CorneaGen at SPS@CorneaGen.com for a prompt follow up.

A simple questionnaire will be provided to collect additional information to expedite reimbursement consultation and support.