• Fact Sheet: Coding for XCELLERATE


    Sponsored in part by a grant from Russell Health, Inc.

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    What it Is

    XCELLERATE is a self-retaining lyophilized membrane that promotes corneal wound healing. It naturally dissolves in 3-5 days but may be removed earlier if the patient’s condition improves.

    CPT Code

    65778 Placement of amniotic membrane on the ocular surface; without sutures

    Global Period and Allowables

    Global Period: 0-day

    Physician: $1494.12 (Office; includes the AMT) / $54.08 (ASC/Hospital)

    ASC: No facility allowable. The ASC must absorb the cost.

    Hospital: $807 (Medicare; includes the AMT)

    The existence of a CPT code and a specific medication code does not ensure coverage or payment amount. You must verify coverage before performing each procedure with each payer.

    Correct Coding Initiative

    65778 is bundled with these CPT codes when performed on the same eye, same day and same surgical session:

    12011, 12013, 12014, 12015, 12016, 12017, 12018, 12051, 12052, 12053, 12054, 12055, 12056, 12057, 13150, 13151, 13152, 13153, 65280, 65286, 65400, 65410, 65435, 65781, 65782, 66020, 67250, 67500, 92012, 92014, 92018, 92019, 92071, 99211, 99212, 99213, 99214, 99215, 99217, 99218, 99219, 99220, 99221, 99222, 99223, 99231, 99232, 99233, 99234, 99235, 99236, 99238, 99239, 99241, 99242, 99243, 99244, 99245, 99251, 99252, 99253, 99254, 99255, 99291, 99292, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 99334, 99335, 99336, 99337, 99347, 99348, 99349, 99350, 99374, 99375, 99377, 99378, G0463

    Mutually Exclusive: V2790, 99149, 99150, 99155, 99156, 99157, 99446, 99447, 99448, 99449, 99495, 99496

    Modifiers

    -25 To bill an exam the same day as the insertion of XCELLERATE, the exam must meet the definition of modifier -25 in that the exam must be significantly and separately identifiable from the insertion. While medically  necessary, if the exam is performed solely to confirm the need for the minor surgery, then the exam is not separately billable.
    -50 When performed bilaterally, Medicare requires 65778 -50 and a “1” in the unit field. Other payers may require modifier -50 and a “2” in the unit field while others may require two lines with modifiers -RT and -LT.
    -59 Unless XCELLERATE is inserted in the other, non-surgical eye, it is not appropriate to unbundle CPT code 65778 from any of the codes in column 2 above.

    ICD-10 Linkages

    Coverage may vary by payer. ICD-10 diagnoses codes may include but are not limited to the following:

    • C69.01 - Malignant neoplasm of right conjunctiva
    • C69.02 - Malignant neoplasm of left conjunctiva
    • C79.49 - Secondary malignant neoplasm of other parts of nervous system
    • D09.21 - Carcinoma in situ of right eye
    • D09.22 - Carcinoma in situ of left eye
    • D31.01 - Benign neoplasm of right conjunctiva
    • D31.02 - Benign neoplasm of left conjunctiva
    • D48.7 - Neoplasm of uncertain behavior of other specified sites (Neoplasm of uncertain behavior of eye, Neoplasm of uncertain behavior of heart, Neoplasm of uncertain behavior of peripheral nerves of orbit)
    • H02.59 - Other disorders affecting eyelid function (Deficient blink reflex, Sensory disorders)
    • H11.021 - Central pterygium of right eye
    • H11.022 - Central pterygium of left eye
    • H11.023 - Central pterygium of eye, bilateral
    • H11.031 - Double pterygium of right eye
    • H11.032 - Double pterygium of left eye
    • H11.033 - Double pterygium of eye, bilateral
    • H11.041 - Peripheral pterygium, stationary, right eye
    • H11.042 - Peripheral pterygium, stationary, left eye
    • H11.043 - Peripheral pterygium, stationary, bilateral
    • H11.051 - Peripheral pterygium, progressive, right eye
    • H11.052 - Peripheral pterygium, progressive, left eye
    • H11.053 - Peripheral pterygium, progressive, bilateral
    • H11.061 - Recurrent pterygium of right eye
    • H11.062 - Recurrent pterygium of left eye
    • H11.063 - Recurrent pterygium of eye, bilateral
    • H11.121 - Conjunctival concretions, right eye
    • H11.122 - Conjunctival concretions, left eye
    • H11.123 - Conjunctival concretions, bilateral
    • H11.231 - Symblepharon, right eye
    • H11.232 - Symblepharon, left eye
    • H11.233 - Symblepharon, bilateral
    • H11.811 - Pseudopterygium of conjunctiva, right eye
    • H11.812 - Pseudopterygium of conjunctiva, left eye
    • H11.813 - Pseudopterygium of conjunctiva, bilateral
    • H16.011 - Central corneal ulcer, right eye
    • H16.012 - Central corneal ulcer, left eye
    • H16.013 - Central corneal ulcer, bilateral
    • H16.021 - Ring corneal ulcer, right eye
    • H16.022 - Ring corneal ulcer, left eye
    • H16.023 - Ring corneal ulcer, bilateral
    • H16.041 - Marginal corneal ulcer, right eye
    • H16.042 - Marginal corneal ulcer, left eye
    • H16.043 - Marginal corneal ulcer, bilateral
    • H16.051 - Mooren's corneal ulcer, right eye
    • H16.052 - Mooren's corneal ulcer, left eye
    • H16.053 - Mooren's corneal ulcer, bilateral
    • H16.071 - Perforated corneal ulcer, right eye
    • H16.072 - Perforated corneal ulcer, left eye
    • H16.073 - Perforated corneal ulcer, bilateral
    • H18.11 - Bullous keratopathy, right eye
    • H18.12 - Bullous keratopathy, left eye
    • H18.13 - Bullous keratopathy, bilateral
    • H18.211 - Corneal edema secondary to contact lens, right eye
    • H18.212 - Corneal edema secondary to contact lens, left eye
    • H18.213 - Corneal edema secondary to contact lens, bilateral
    • H18.421 - Band keratopathy, right eye
    • H18.422 - Band keratopathy, left eye
    • H18.423 - Band keratopathy, bilateral
    • H18.461 - Peripheral corneal degeneration, right eye
    • H18.462 - Peripheral corneal degeneration, left eye
    • H18.463 - Peripheral corneal degeneration, bilateral
    • H18.49 - Other corneal degeneration
    • H18.821 - Corneal disorder due to contact lens, right eye
    • H18.822 - Corneal disorder due to contact lens, left eye
    • H18.823 - Corneal disorder due to contact lens, bilateral
    • H18.831 - Recurrent erosion of cornea, right eye
    • H18.832 - Recurrent erosion of cornea, left eye
    • H18.833 - Recurrent erosion of cornea, bilateral
    • L51.1 - Stevens-Johnson syndrome
    • Q13.1 - Absence of iris (Aniridia)
    • T26.01XA - Burn of right eyelid and periocular area, initial encounter
    • T26.02XA - Burn of left eyelid and periocular area, initial encounter
    • T26.11XA - Burn of cornea and conjunctival sac, right eye, initial encounter
    • T26.12XA - Burn of cornea and conjunctival sac, left eye, initial encounter
    • T26.51XA  -Corrosion of right eyelid and periocular area, initial encounter
    • T26.52XA - Corrosion of left eyelid and periocular area, initial encounter
    • T26.61XA - Corrosion of cornea and conjunctival sac, right eye, initial encounter
    • T26.62XA - Corrosion of cornea and conjunctival sac, left eye, initial encounter

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