65780
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
6.85
Facility
$516.04
Non-Facility
$516.04
Documentation Required
- When billing HCPCS V2790 with CPT 65780 on the same claim, submit a copy of the invoice with the claim.
- For electronic claims, submit the invoice via fax.
- For paper claims, submit the actual invoice with the claim.
- This invoice submission instruction is effective for dates of service on or after September 4, 2012.
Key Coverage Criteria
- HCPCS V2790 is bundled and included in the allowance when billed with CPT 65778.
- HCPCS V2790 is bundled and included in the allowance when billed with CPT 65779.
- HCPCS V2790 may be reimbursed separately in an office setting when billed on the same claim with CPT 65780 and an invoice is submitted with the claim.
- In inpatient facility cases, the cost of HCPCS V2790 is included in the Outpatient Prospective Payment System (OPPS) allowance.
- In Ambulatory Surgical Center (ASC) cases, the cost of HCPCS V2790 is included in the ASC facility allowance.
- Aniridia (hereditary)
4 Active Policies
AETNA-CPB-0293 — Corneal Graft and Amniotic Membrane Transplantation, Corneal Stromal Lenticule Transplantation, Limbal Stem Cell Transplantation, or Sural Nerve Grafting for Ocular Indications
AETNA-CPB-0566 — Strabismus Repair
A53441 — Billing and Coding: Amniotic Membrane Billing Guidelines for HCPCS Code V2790
ANTHEM-CG-SURG-127 — CG-SURG-127 Products for Wound Healing and Soft Tissue Grafting: Medically Necessary Uses
Related Codes
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