REIMBURSEMENT FOR AMNIOTIC TISSUE-CPT Code 65778
Amniotic Patches are used primarily in the treatment of acute and chronic cornea surface wounds and defects. It may be used as a graft to facilitate ocular tissue repair or as a biological dressing to protect the ocular surface. As a graft, it provides a natural substrate that is conducive for migration and attachment of the patient’s own epithelial cells.1 As a biological dressing, it shields the regenerating epithelium from frictional forces during the healing process and protects the underlying stroma if it is inflamed or scared.1 Some common conditions for which amniotic tissues may be used include:
- Chemical burns of the ocular surface
- Corneal epithelial defects such as:
- Bullous or band keratopathy
- Epithelial basement membrane dystrophy
- Recurrent corneal erosions
- Keratitis (exposure, neurotrophic, filamentary, bacterial or viral)
- Postop care after corneal procedures
- Postop care after pterygium surgery
- Corneal ulcer
- Partial limbal stem-cell deficiency
- Persistent epithelial defects
- Stevens-Johnson Syndrome
CPT code 65778 describes this procedure: “Placement of amniotic membrane on the ocular surface; without sutures”. CPT code 92071, “fitting of contact lens for treatment of ocular surface disease” is not separately billable with concurrent 65778; CMS NCCI bundling edits apply.
Q: What is the Medicare allowed amount for 65778?
A: Payment rates vary by site of service. In 2018, the Medicare Physician Fee Schedule allowed amounts are:
- Physician (in-office) $1,448
- Physician (in-facility) $58
The large site-of-service differential between physician reimbursement in-office and in-facility is due to the supply. Payment for the supply is not made to the physician when the procedure is performed in a facility, and vice versa.
These amounts are adjusted in each locality by local indices. Other payers set their own fee schedules, which may differ considerably from Medicare rates.
Q: Does Medicare pay for the supply of the amniotic tissue separately?
A: No. HCPCS code V2790, Amniotic membrane for surgical reconstruction per procedure, is no longer eligible for discrete Medicare payment in any setting. Reimbursement for the supply is included with payment for the procedure.
Other payers may have different policies regarding amniotic tissue. Check with your payers.
As always check with your healthcare lawyer prior to adding any new procedures and billing to your practice!