Corneal collagen cross-linking (CXL) is a photochemical procedure for the treatment of progressive keratoconus and corneal ectasia. Keratoconus is a dystrophy of the cornea characterized by progressive deformation (steepening) of the cornea while corneal ectasia is keratoconus that occurs after refractive surgery. Both lead to functional loss of vision and the need for corneal transplantation.
Collagen crosslinks are biochemical markers which provide a measurement of bone resorption.
CXL using riboflavin and ultraviolet A may be considered medically necessary in individuals who have failed conservative treatment (e.g., spectacle correction, rigid contact lens) when used for EITHER of the following conditions;
CXL using riboflavin and ultraviolet A is considered experimental/investigational and therefore non-covered for all other indications because of insufficient supporting evidence in peer-reviewed literature.
Collagen crosslinks, any method, is considered not medically necessary.
Covered diagnosis codes for procedure code 0402T
Internal Medical Policy Committee 1-22-2020 Annual Review
Current medical policy is to be used in determining a Member's contract benefits on the date that services are rendered. Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. Likewise, medical policy, which addresses the issue(s) in any specific case, should be considered before utilizing medical opinion in adjudication. Medical technology is constantly evolving and the Company reserves the right to review and update medical policy periodically.