Endothelial Cell Photography

Number: 0538

Policy

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.

Table: CPT Codes / HCPCS Codes / ICD-10 Codes
Code Code Description

Information in the [brackets] below has been added for clarification purposes.   Codes requiring a 7th character are represented by "+":

CPT codes covered if selection criteria are met:
92286 Special anterior segment photography with interpretation and report; with specular endothelial microscopy and cell count
92287     with fluorescein angiography

ICD-10 codes covered if selection criteria are met (not all-inclusive):
H18.10 - H18.239 Bullous keratopathy and other and unspecified corneal edema
H18.51 Endothelial corneal dystrophy
H18.59 Other hereditary corneal dystrophies

The above policy is based on the following references:

  1. American Academy of Ophthalmology Preferred Practice Patterns Committee. Comprehensive adult medical eye evaluation. San Francisco, CA: American Academy of Ophthalmology; 2010.
  2. American Academy of Ophthalmology Refractive Management/Intervention Panel. Refractive errors & refractive surgery. San Francisco, CA: American Academy of Ophthalmology; 2007.
  3. American Academy of Ophthalmology. Corneal endothelial photography. Three-year revision.  Ophthalmology. 1997;104(8):1360-1365 (updated 2008).
  4. Chiou AG, Kaufman SC, Kaufman HE, Beuerman RW. Clinical corneal confocal microscopy. Surv Ophthalmol. 2006;51(5):482-500.
  5. 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.  
  6. 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.
  7. Klais CM, Buhren J, Kohnen T. Comparison of endothelial cell count using confocal and contact specular microscopy. Ophthalmologica. 2003;217(2):99-103.
  8. 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.
  9. 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.
  10. 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.
  11. Wisconsin Physician Service Insurance Corporation (WPS) Medicare Part B. Endothelial cell photography. Medicare Policy No. OPHTH-012. Madison, WI: WPS; October 1, 1994.