Aetna considers computerized corneal topography medically necessary for any of the following conditions:
* Generally, 1 testing for each eye is sufficient for fitting, unless there is some reason for repeat testing conducted in the medical record, such as a change in the member's condition from the prior examination. Repeat testing to monitor disease progression in keratoconus or Terrien's marginal degeneration may be necessary over time.
Note: Aetna does not cover corneal topography if it is performed pre- or post-operatively in relation to a non-covered procedure (i.e., refractive eye surgery). Most Aetna benefit plans exclude coverage of refractive surgery. Please check benefit plan descriptions for details.
Aetna considers corneal topography experimental and investigational if it is performed as part of pre-operative assessment of members with cataracts (see CPB 0508 - Cataract Removal Surgery).
Aetna considers corneal topography experimental and investigational for the management of members with the following indications (not an all-inclusive list) because corneal topography has not been shown to alter the clinical management of these conditions such that clinical outcomes are improved.
- Acanthomoeba keratitis
- Epithelial ingrowth following laser in situ keratomileusis (LASIK)
- Interstitial keratitis
- Lens subluxation (e.g., in Marfan syndrome)
- Limbal dermoids
- Nodular degeneration of the cornea (e.g., Salzmann's corneal degeneration)
- Ocular graft-versus-host disease
- Open-angle glaucoma
- Superficial punctate keratopathy.
Computerized corneal topography (also known as computer assisted corneal topography, computer assisted keratography, or videokeratography) is a computer- assisted diagnostic technique in which a special instrument projects a series of light rings on the cornea, creating a color-coded map of the corneal surface as well as a cross-section profile. This test is used for the detection of subtle corneal surface irregularities and astigmatism as an alternative to manual keratometry.
The American Academy of Ophthalmology’s guidelines on “Primary open-angle glaucoma” (AAO, 2010) mentioned no role for corneal topography in the management of patients with open-angle glaucoma.
Choi and Kim (2012) examined the longitudinal changes in corneal topographic indices over time in patients with mild keratoconus (KC) and determined predictive factors for the increase in corneal curvature. These investigators retrospectively reviewed the data of 94 eyes of patients with mild KC who had undergone computerized video-keratography (Orbscan IIz; Bausch & Lomb Surgical, Rochester, NY) at least twice at an interval of greater than or equal to 1 year. Patients with an increase of greater than or equal to 1.50 diopters (D) in the central keratometry (K) were placed in the progression group, and the others were placed in the non-progression group. In each group, the quantitative topographic parameters were compared and tested as predictive factors for KC progression. Additionally, corneal astigmatic changes were evaluated by means of vector analysis. In total, 94 eyes of 85 patients were included -- 25 of 94 (26.5 %) eyes showed progression of the central K greater than or equal to 1.50 D; progression took 3.5 years on average. Median time to progression by Kaplan-Meier analysis was 12 years. Significant predictors for KC progression were as follows: highest point on the anterior elevation from the anterior best-fit sphere (BFS), greater than or equal to 0.04 mm; irregularity index at 3 mm, greater than or equal to 6.5 D; irregularity index at 5 mm, greater than or equal to 6.0 D; thinnest pachymetry, less than 350 μm at baseline examination; yearly change rate of anterior BFS, greater than or equal to 0.1 D/year; central K, greater than or equal to 0.1 D/year; simulated K in maximum, greater than or equal to 0.15 D/year; simulated K in minimum, greater than or equal to 0.2 D/year; and anterior chamber depth, greater than or equal to 0.0 mm/year. The dominant with-the-rule pattern of astigmatism at the baseline examination was changed to an oblique pattern of astigmatism at the last examination. The authors concluded that mild KC tended to be progressive in approximately 25 % of patients, and progression lasted 3.5 years on average. They stated that longitudinal changes in the corneal topography quantitative indices can be used as predictors of KC progression.
|CPT Codes / HCPCS Codes / ICD-9 Codes|
|CPT codes covered if selection criteria are met:|
|92025||Computerized corneal topography, unilateral or bilateral, with interpretation and report|
|Other CPT codes related to the CPB:|
|65710 - 65775||Keratoplasty and other corneal procedures|
|76514||Ophthalmic ultrasound, diagnostic; corneal pachymetry, unilateral or bilateral (determination of corneal thickness)|
|92071||Fitting of contact lens for treatment of ocular surface disease|
|92310 - 92326||Contact lens services|
|HCPCS codes covered if selection criteria are met:|
|S0820||Computerized corneal topography, unilateral|
|Other HCPCS codes related to the CPB:|
|S0592||Comprehensive contact lens evaluation|
|S0810||Photorefractive keratectomy (PRK)|
|S0812||Phototherapeutic keratectomy (PTK)|
|ICD-9 codes covered if selection criteria are met:|
|370.00 - 370.07||Corneal Ulcer|
|371.00||Corneal opacity, unspecified|
|371.01||Minor opacity of cornea [post-traumatic scarring]|
|371.02||Peripheral opacity of cornea [post-traumatic scarring]|
|371.03||Central opacity of cornea [post-traumatic scarring]|
|371.48||Peripheral degeneration of cornea [Terrien's marginal degeneration]|
|371.50 - 371.58||Hereditary corneal dystrophies|
|371.60 - 371.62||Keratoconus|
|372.40 - 372.45||Pterygium|
|743.41||Anomalies of corneal size and shape|
|996.51||Mechanical complications due to corneal graft|
|ICD-9 codes not covered for indications listed in the CPB (not all-inclusive):|
|136.21||Specific infection due to acanthameoba|
|224.4||Benign neoplasm of cornea [limbal dermoids]|
|279.50 - 279.53||Graft-versus-host disease|
|365.10 - 365.15||Open-angle glaucoma|
|366.00 - 366.9||Cataract|
|370.21||Punctate keratitis [Ocular]|
|370.50 - 370.59||Interstitial and deep keratitis|
|370.8||Other forms of keratitis [acanthamoeba keratitis]|
|371.46||Nodular degeneration of cornea (e.g., Salzmann's nodular dystrophy)|
|379.32||Subluxation of lens|
|379.33||Anterior dislocation of lens|
|379.34||Posterior dislocation of lens|
|743.30 - 743.34||Congenital cataract|