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Big Win for Surgery Centers: CMS Ensures Fair Reimbursement for Glaucoma Shunt Procedures

Ophthalmology was a powerful influence in agency’s decision to pay separately for donor tissue used for patch grafts

Following a nearly year-long push by the American Academy of Ophthalmology and American Glaucoma Society, the Centers for Medicare & Medicaid Services has created a fair pathway for Medicare facilities to be reimbursed for glaucoma shunt procedures.

Effective April 1, ambulatory surgery centers will be able to bill separately for cornea tissue obtained through an eye bank when used by ophthalmologists for placement or revision of glaucoma aqueous shunts. More than 53 percent of these procedures are performed in an ambulatory surgery center.

This decision is significant to beneficiaries because a large portion of shunt procedures performed in ambulatory surgery centers would have been shifted to the more costly hospital outpatient setting. 

Surgery centers can now bill for cornea allograft tissue used for coverage (66180) or revision (66185) of glaucoma aqueous shunts by using code V2785. This is similar to the billing for cornea allograft tissue associated with cornea transplant procedures.

The Academy pressed CMS to provide a fair way for physicians to be reimbursed after the agency announced that facility payments for several eye procedures when performed in a surgery center were going to be reduced significantly starting this year. The agency consolidated ambulatory payment of ophthalmic procedures from 24 classifications down to 13. The consolidation hit glaucoma shunt surgeries with grafts particularly hard and threatened patient access. 

Download a Q&A that may address questions that you have concerning glaucoma aqueous shunt codes and patch graft changes.

Send questions or comments to cmoye@aaodc.org.