HCPCS code V2790 (amniotic membrane for surgical reconstruction, per procedure) is included in the allowance for CPT Codes 65778 and 65779. In an inpatient facility reimbursement for HCPCS code V2790 is included in the Outpatient Prospective Payment System (OPPS) allowance. In an Ambulatory Surgical Center (ASC) reimbursement for V2790 is included in the facility allowance.
HCPCS code V2790 (amniotic membrane for surgical reconstruction, per procedure) should not be billed to Part B separately except as noted below:
•HCPCS code V2790 can be reimbursed separately in an office setting when billed with CPT Code 65780. A copy of the invoice must be submitted when billing for V2790 and 65780 on the same claim.
•HCPCS code V2790 should not be billed with CPT Code 65775. However, if amniotic membrane application is required in the course of that procedure, then either CPT Codes 65778 or 65779, depending on the method of application of the membrane must be billed with 65775 when a membrane is applied. As indicated above, CPT Codes 65778 and 65779 both include payment for the membrane itself (V2790) and therefore V2790 should not be billed separately when those codes are billed.
Documentation That Must Be Submitted with Claim
•For electronic claims, submit an invoice via fax.
•For paper claims, please submit the actual invoice with the claim.
This instruction is effective for dates of service on or after September 4, 2012.