Aetna considers endothelial cell photography medically necessary for members with any of the following indications:
Are about to be fitted with extended wear contact lenses after intraocular surgery; or
Are about to undergo a secondary intraocular lens implantation; or
Are about to undergo a surgical procedure associated with a higher risk to corneal endothelium; or
Have had previous intraocular surgery and require cataract surgery; or
Have slit-lamp evidence of corneal edema (unilateral or bilateral); or
Have slit-lamp evidence of endothelial dystrophy (corneal guttata, i.e., Fuch's dystrophy); or
With evidence of posterior polymorphous dystrophy of the cornea or irido-corneal endothelium syndrome.
Aetna considers endothelial cell photography experimental and investigational for other indications because it has no proven clinical value for other indications.
Note: Endothelial cell photography is considered an integral part of the pre-surgical comprehensive or brief/intermediate eye examination when done prior to cataract surgery when the member's only visual problem is cataracts. This is true regardless of the type of cataract technique utilized (including phaco-emulsification).
Background
Endothelial cell photography (also known as specular endothelial microscopy, anterior segment photography, and corneal endothelial microscopy) involves the use of a specular microscope to determine the endothelial cell count. It is used by ophthalmologists to predict success of ocular surgery and other ocular procedures.
CPT Codes / HCPCS Codes / ICD-9 Codes
CPT codes covered if selection criteria are met:
92286
92287
ICD-9 codes covered if selection criteria are met (not all-inclusive):
371.20 - 371.24
Corneal edema
371.57
Endothelial corneal dystrophy
371.58
Other posterior corneal dystrophies
Other ICD-9 codes related to the CPB:
366.00 - 366.9
Cataract
743.30 - 743.34
Congenital cataract
996.53
Mechanical complications due to ocular lens prosthesis
V43.1
Replacement of lens by prosthesis
The above policy is based on the following references:
Wisconsin Physician Service Insurance Corporation (WPS) Medicare Part B. Endothelial cell photography. Medicare Policy No. OPHTH-012. Madison, WI: WPS; October 1, 1994. Available at: http://www.wpsic.com/medicare/policy/wisconsin/opht12W.html. Accessed April 3, 2000.
U.S. Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research (AHCPR). Cataract in adults: Management of functional impairment. Clinical Practice Guideline No. 4. AHCPR Publication No. 93-0544. Rockville, MD: AHCPR; February 1993.
American Academy of Ophthalmology. Corneal endothelial photography. Three-year revision. Ophthalmology. 1997;104(8):1360-1365 (updated for currency 2008).
U.S. Department of Health and Human Services, Health Care Financing Administration (HCFA). Endothelial cell photography. Medicare Coverage Issues Manual §50-38. HCFA Publication No. 6. Baltimore, MD: HCFA; 2000.
Modis L Jr, Langenbucher A, Seitz B. Corneal endothelial cell density and pachymetry measured by contact and noncontact specular microscopy. J Cataract Refract Surg. 2002;28(10):1763-1769.
Hara M, Morishige N, Chikama T, Nishida T. Comparison of confocal biomicroscopy and noncontact specular microscopy for evaluation of the corneal endothelium. Cornea. 2003;22(6):512-515.
Klais CM, Buhren J, Kohnen T. Comparison of endothelial cell count using confocal and contact specular microscopy. Ophthalmologica. 2003;217(2):99-103.
de Sanctis U, Machetta F, Razzano L, et al. Corneal endothelium evaluation with 2 noncontact specular microscopes and their semiautomated methods of analysis. Cornea. 2006;25(5):501-506.
American Academy of Ophthalmology Refractive Management/Intervention Panel. Refractive errors & refractive surgery. San Francisco, CA: American Academy of Ophthalmology; 2007.
American Academy of Ophthalmology Preferred Practice Patterns Committee. Comprehensive adult medical eye evaluation. San Francisco, CA: American Academy of Ophthalmology; 2010.
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.
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