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Reimbursement for DSEK/DSAEK

Topic: DSEK

Sponsor: Corcoran Consulting Group

Updated: 04/16/2019

Corcoran Consulting Group

Descemet’s stripping endothelial keratoplasty (DSEK) or Descemet’s stripping automated endothelial keratoplasty (DSAEK) are interchangeable terms for a corneal transplantation that replaces just the posterior diseased cornea, leaving the corneal surface relatively untouched. The procedure involves a small corneal incision through which the surgeon strips away diseased or opacified corneal endothelial cells and grafts the posterior ¼ to ⅓ donor cornea thickness to the inner surface of the recipient cornea.

This FAQ addresses the following:

  1. What is DSEK/DSAEK?
  2. When is DSEK/DSAEK indicated?
  3. Does Medicare cover this procedure?
  4. What CPT code(s) are used to describe DSEK/DSAEK?
  5. What is the Medicare reimbursement for DSEK/DSAEK?
  6. Does DSEK/DSAEK have a global surgical period?
  7. If surgery is performed in a HOPD or ASC, will Medicare pay a facility fee?
  8. How is the supply of tissue reimbursed?
  9. If there is an immediate postoperative pressure spike, is the post-operative visit billable?
  10. How is a reoperation billed if it requires a return to the operating room?
  11. Can DSEK/DSAEK be combined with cataract surgery?