JAN 05, 2015
Clarifications from CMS: Dropless Cataract Surgery Billing and Corneal Transplant Tissue Coding
No Separate Billing for Dropless Cataract Surgery
CMS has provided clear guidance to carriers that periocular injections of combined anti-inflammatory drugs and antibiotics (commonly referred to as “dropless” cataract surgery) are never separately payable. Injections are a part of the ocular surgery and are included in the CPT codes used to report the surgical procedure. CMS also warns that physicians or facilities cannot circumvent packaged payments in the HOPD or ASC by instructing beneficiaries to purchase and bring these drugs to the facility for administration.
Coding for Corneal Transplant Tissue
CMS has reiterated its long-standing policy that corneal tissue is to be paid on a cost basis and not under the Outpatient Perspective Payment System. There have been reports of such facility claims being denied. Facilities should bill separately based on the invoice using HCPCS code. The Academy and the Eye Bank Association of America (EBAA) had requested that CMS reaffirm this policy.