BrightMEM Reimbursement Guide

A sample of content in this file:

Introduction
Brightstar Therapeutics is dedicated to providing its customers with professional reimbursement
and medical claims assistance at no charge. Our aim is to support billing for BrightMEM
corneal allograft to Medicare and other commercial insurance carriers. In collaboration with
NMD Healthcare, we offer guidance on coding, coverage, and reimbursement inquiries.
This comprehensive guide is designed to assist surgeons and facilities performing corneal
transplants in effectively billing for reimbursement through Medicare and commercial payers.
Product Description
BrightMEM Anterior Keratoplasty (BMAK) is a surgical procedure that utilizes a BrightMEM
corneal allograft to improve the conditions of the ocular surface to support the survival,
maturation, and multiplication of corneal epithelial cells.
The product is aseptically processed from tissues obtained from donated human tissue
(corneas) according to the current Good Tissue Practices (cGTP) regulations established
by the US Food & Drug Administration (FDA)..
Reimbursement for the Acquisition of Corneal Tissue
Medicare provides separate payment to hospital outpatient departments and Ambulatory Surgery
Centers for corneal tissue acquisition used in corneal surgeries.
This payment is in addition to the payment to the surgeon. The reimbursement for corneal or donor
tissue acquisition is based on the cost and is not included in the outpatient prospective payment
system or the APC payment for the surgical procedure. To receive this cost-based reimbursement,
the hospital outpatient department must bill separately for the corneal or donor tissue acquisition
using HCPCS code V2785 on the UB-04 hospital claim form. Under the ASC payment system,
Medicare makes separate payments to ASCs for corneal tissue acquisition. Payment is based on
acquisition cost or invoice.” Report V2785 on the Medicare 1500 claim form submitted to payers.
The Eye Bank Association of America and AAO have provided further information about the
appropriate billing of the cost for the acquisition of corneal tissue at:
restoresight.org/medicare-reimbursement.