CPT Code 65780

CPT code 65780 is a medical billing code for an ocular surface reconstruction using a transplant.

Accelerate your revenue cycle

Boost patient experience and your bottom line by automating patient cost estimates, payer underpayment detection, and contract optimization in one place.

Get a Demo

What is CPT Code 65780

CPT code 65780 is designated for an ocular surface reconstruction procedure, specifically involving the transplantation of amniotic membrane to the eye. This procedure is typically used to treat conditions that affect the surface of the eye, such as severe dry eye, chemical burns, or other ocular surface disorders that have not responded to conventional treatments. The code covers the surgical placement of the amniotic membrane, which helps in healing and provides a protective layer to facilitate ocular surface reconstruction.

Does CPT 65780 Need a Modifier?

For CPT code 65780 (Ocular surface reconstruction; amniotic membrane transplantation), several modifiers may be applicable depending on the specific circumstances of the surgery and billing requirements. Here’s an ordered list of common modifiers that could be used with this procedure and the reasons for each:

1. -22 (Increased Procedural Services): This modifier is used when the work required to perform the surgery is substantially greater than typically required. Documentation must support the significant additional work and the reason for it.

2. -51 (Multiple Procedures): Use this modifier when this procedure is performed at the same session as other procedures. It indicates that multiple procedures were performed on the same day.

3. -52 (Reduced Services): If the procedure is partially reduced or eliminated at the physician's discretion, this modifier should be applied to indicate that a service or procedure was partially reduced or eliminated.

4. -53 (Discontinued Procedure): Applied when a procedure is terminated after the beginning of the surgery due to extenuating circumstances or those that threaten the well-being of the patient.

5. -54 (Surgical Care Only): When one physician performs a surgical procedure and another provides preoperative and/or postoperative management, this modifier is used.

6. -55 (Postoperative Management Only): Used when one physician performs the postoperative management and another physician performed the surgical procedure.

7. -56 (Preoperative Management Only): Indicates that a physician performed the preoperative care only, and another physician performed the surgical procedure.

8. -58 (Staged or Related Procedure or Service by the Same Physician During the Postoperative Period): This modifier is used when a staged or related procedure is performed during the postoperative period of the initial procedure.

9. -59 (Distinct Procedural Service): Indicates that procedures that are not normally reported together are appropriate under the circumstances. This can be used when different sessions, surgical sites, or procedures are performed.

10. -78 (Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period): This modifier is used when a second procedure is performed as an unplanned event related to the first procedure.

11. -79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): Used when a procedure performed during the postoperative period is unrelated to the original procedure.

12. -RT and -LT (Right and Left): Used to indicate that the procedure was performed on the right or left eye, respectively.

13. -XA (Separate Encounter): A service that is distinct because it occurred during a separate encounter.

14. -XS (Separate Structure): A service that is distinct because it was performed on a separate organ/structure.

15. -XP (Separate Practitioner): A service that is distinct because it was performed by a different practitioner.

16. -XU (Unusual Non-Overlapping Service): The use of a service that is distinct because it does not overlap usual components of the main service.

Each of these modifiers provides specific information that helps in the accurate processing and reimbursement of claims for CPT code 65780. Proper documentation and justification are crucial when using any modifier to ensure compliance and appropriate payment.

CPT Code 65780 Medicare Reimbursement

CPT code 65780, which pertains to ocular surface reconstruction using a cellular or tissue-based product, is generally reimbursable by Medicare under specific conditions. The reimbursement for this procedure, however, can vary based on the Medicare Administrative Contractor (MAC) jurisdiction, the setting in which the procedure is performed (such as inpatient or outpatient), and other factors such as the specific product used for the transplant.

To determine the exact reimbursement amount for CPT code 65780, it is advisable to consult the fee schedule provided by the local MAC, as these schedules provide detailed information on the allowable charges for procedures covered by Medicare. Additionally, it's important to ensure that all documentation and coding are accurately completed to meet Medicare's requirements for medical necessity and compliance.

For healthcare providers, staying updated with the latest Medicare fee schedules and guidelines is crucial for ensuring proper reimbursement for services like those described by CPT code 65780.

Are You Being Underpaid for 65780 CPT Code?

Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately detecting underpayments. With the capability to analyze contracts and identify discrepancies down to specific CPT codes, such as 65780 for ocular reconstructive transplantation, RevFind ensures that each claim is fully compensated according to your payer agreements. Schedule a demo today to see how RevFind can help secure the payments you are entitled to for every procedure billed.

Get paid in full by bringing clarity to your revenue cycle

Full Page Background