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V2790 not paid with 65426 & 65780

  1. #1
    Question V2790 not paid with 65426 & 65780
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    Our ASC is having an issue with performing the 65780 or the 65426. The V2790 is not separately reimburseable. The cost for the membrane alone is around $500 and medicare is only reimbursing approx 1000 for the 65426 & 1400 for the 65780. This procedure doesn't seem cost effective.

    Does anyone know any way to get payment for the amniotic membrane? Either from the insurance or the patient. Of course within HIPAA guidelines.

    Our ASC is contemplating not doing these procedures.

    Please give me your feedback.

  2. #2
    V2790 has a status inidcator of N1 for Medicare which means it is not separately reimburseable....unfortunately since Medicare considers it packaged into the reimbursement for the procedure you cannot bill the patient for the cost of the membrane either...We have decided not to perform these procedures at our facility for that reason...hope this helps

  3. #3
    That's what I was thinking too but was hoping to find a loop hole somewhere.

    Thank you.

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