Summary & Overview
HCPCS Level II V2790: Amniotic Membrane for Surgical Reconstruction
HCPCS Level II code V2790 identifies the use of amniotic membrane for surgical reconstruction, billed per procedure. The code captures a biologic graft product employed across surgical specialties to support wound healing, ocular and soft-tissue reconstruction, and other reparative surgical applications. Its national relevance stems from growing use of biologic and tissue-based products in reconstructive surgery and the need for clear billing pathways.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of payer coverage patterns, coding and billing considerations, and clinical contexts where V2790 is commonly applied. The publication summarizes benchmarks for utilization where available, highlights policy updates affecting coverage and documentation expectations, and provides clinical context for typical sites of service and procedure types that use this product.
This summary is intended for coding professionals, revenue cycle staff, and clinicians seeking a concise reference on the code's purpose, payer landscape, and the kinds of metrics and policy information typically relevant when billing for amniotic membrane used in surgical reconstruction.
Billing Code Overview
HCPCS Level II code V2790 denotes Amniotic membrane for surgical reconstruction, per procedure. This code represents the surgical use of processed amniotic membrane tissue applied during reconstructive procedures to support wound healing, tissue regeneration, or repair.
Service Type: Surgical reconstructive tissue graft or biologic implant
Typical Site of Service: Operating room or surgical suite, outpatient procedure centers, or hospital inpatient surgical settings
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult presenting to an ophthalmology or oculoplastic surgical service with a corneal or conjunctival surface defect, persistent epithelial defect, non-healing corneal ulcer, symblepharon, or for ocular surface reconstruction following trauma or tumor excision. After evaluation in clinic, conservative measures (lubrication, antibiotics, therapeutic contact lens) failed or were inadequate. The patient is scheduled for an operative procedure in an ambulatory surgery center or hospital operating room where cryopreserved or dehydrated amniotic membrane is applied to the ocular surface for epithelial support, to reduce inflammation, promote healing, or reconstruct conjunctival or tarsal surfaces. The clinical workflow includes preoperative assessment, informed consent, sterile preparation, debridement or excision of devitalized tissue as indicated, sizing and placement of the amniotic membrane (sutured, glued, or as a graft or patch), possible concurrent procedures (e.g., tarsorrhaphy, symblepharon lysis, keratectomy), postoperative topical medications, and follow-up visits to monitor epithelialization and graft integration. Typical sites of service are ophthalmology outpatient surgical centers, hospital outpatient departments, or physician offices with procedure capability for minor ocular surgery.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work required is substantially greater than typical (document rationale). |