Does V2790 require prior authorization?

No, V2790 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for V2790?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

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`V2790`, Amniotic membrane for surgical reconstruction, per procedure

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

When billing HCPCS V2790 with CPT 65780 on the same claim, submit a copy of the invoice with the claim.
For electronic claims, submit the invoice via fax.

For allo-limbal transplants or allogeneic corneal epithelial stem cell transplantation: documentation of donor source (living-related, cadaver), HLA matching if applicable, and planned systemic immunosuppression regimen and monitoring.

For autologous ex-vivo expanded limbal epithelial transplantation: documentation of donor biopsy site, cell culture method and characteristics (e.g., percentage of p63-bright holoclone-forming stem cells) when available and pertinent to prognosis.

Key Coverage Criteria

HCPCS V2790 is bundled and included in the allowance when billed with CPT 65778.
HCPCS V2790 is bundled and included in the allowance when billed with CPT 65779.
HCPCS V2790 may be reimbursed separately in an office setting when billed on the same claim with CPT 65780 and an invoice is submitted with the claim.
In inpatient facility cases, the cost of HCPCS V2790 is included in the Outpatient Prospective Payment System (OPPS) allowance.
In Ambulatory Surgical Center (ASC) cases, the cost of HCPCS V2790 is included in the ASC facility allowance.
Aniridia (hereditary)

4 Active Policies

HUMANA-OCULAR-SURFACE-DISEASE-DIAGNOSIS-AND-TREATMENTS-MA, Ocular Surface Disease Diagnosis and Treatments

ANTHEM-CG-SURG-127, Products for Wound Healing and Soft Tissue Grafting: Medically Necessary Uses

A53441, Billing and Coding: Amniotic Membrane Billing Guidelines for HCPCS Code V2790

AETNA-CPB-0293, Corneal Graft and Amniotic Membrane Transplantation, Corneal Stromal Lenticule Transplantation, Limbal Stem Cell Transplantation, or Sural Nerve Grafting for Ocular Indications

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V2790, Amniotic membrane for surgical reconstruction, per procedure