Pre- and post-penetrating keratoplasty and post kerato-refractive surgery for irregular astigmatism (subject to medical necessity criteria for these procedures - see CPB 0023 - Corneal Remodeling); or
Pterygium or pseudo pterygium.
* 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.
Epithelial ingrowth following laser in situ keratomileusis (LASIK)
Lens subluxation (e.g., in Marfan syndrome)
Nodular degeneration of the cornea (e.g., Salzmann's corneal degeneration)
Ocular graft-versus-host disease
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.
CPT Codes / HCPCS Codes / ICD-9 Codes
CPT codes covered if selection criteria are met:
Computerized corneal topography, unilateral or bilateral, with interpretation and report
Other CPT codes related to the CPB:
65710 - 65775
92310 - 92326
HCPCS codes covered if selection criteria are met:
Computerized corneal topography, unilateral
Other HCPCS codes related to the CPB:
Comprehensive contact lens evaluation
Photorefractive keratectomy (PRK)
Phototherapeutic keratectomy (PTK)
ICD-9 codes covered if selection criteria are met:
370.00 - 370.07
Corneal opacity, unspecified
Minor opacity of cornea [post-traumatic scarring]
Peripheral opacity of cornea [post-traumatic scarring]
Central opacity of cornea [post-traumatic scarring]
Peripheral degeneration of cornea [Terrien's marginal degeneration]
371.50 - 371.58
Hereditary corneal dystrophies
371.60 - 371.62
372.40 - 372.45
Anomalies of corneal size and shape
Mechanical complications due to corneal graft
ICD-9 codes not covered for indications listed in the CPB (not all-inclusive):
Specific infection due to acanthameoba
Benign neoplasm of cornea [limbal dermoids]
279.50 - 279.53
365.10 - 365.15
366.00 - 366.9
Punctate keratitis [Ocular]
370.50 - 370.59
Interstitial and deep keratitis
Other forms of keratitis [acanthamoeba keratitis]
Nodular degeneration of cornea (e.g., Salzmann's nodular dystrophy)
Subluxation of lens
Anterior dislocation of lens
Posterior dislocation of lens
743.30 - 743.34
The above policy is based on the following references:
Agency for Healthcare Policy and Research (AHCPR), Cataract Management Guideline Panel. Cataract in adults: Management of functional impairment. Clinical Practice Guideline No. 4. AHCPR Pub. No. 93-0542. Rockville, MD: AHCPR; February 1993.
Seitz B, Behrens A, Langenbucher A. Corneal topography. Curr Opin Ophthalmol. 1997;8(4):8-24.
Wilson SE, Klyce SD. Advances in the analysis of corneal topography. Surv Ophthalmol. 1991;35(4):269-277.
Morrow GL, Stein RM. Evaluation of corneal topography: Past, present and future trends. Can J Ophthalmol. 1992;27(5):213-225.
Sanders DR, Gills JP, Martin RG. When keratometric measurements do not accurately reflect corneal topography. J Cataract Refract Surg. 1993;19 Suppl:131-135.
Sultan G, Baudouin C, Auzerie O, et al. Cornea in Marfan disease: Orbscan and in vivo confocal microscopy analysis. Invest Ophthalmol Vis Sci. 2002;43(6):1757-1764.
Rapuano CJ. Management of epithelial ingrowth after laser in situ keratomileusis on a tertiary care cornea service. Cornea. 2010;29(3):307-313.
Caster AI, Friess DW, Schwendeman FJ. Incidence of epithelial ingrowth in primary and retreatment laser in situ keratomileusis. J Cataract Refract Surg. 2010;36(1):97-101.
American Academy of Ophthalmology (AAO) Glaucoma Panel. Primary open-angle glaucoma. Preferred Practice Pattern. San Francisco, CA: AAO; October 2010.
Visser N, Berendschot TT, Verbakel F, et al. Comparability and repeatability of corneal astigmatism measurements using different measurement technologies. J Cataract Refract Surg. 2012;38(10):1764-1770.
Copyright Aetna Inc. All rights reserved. Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Treating providers are solely responsible for medical advice and treatment of members. This Clinical Policy Bulletin may be updated and therefore is subject to change.