Intrastromal Corneal Ring Segments
Insertion of intrastromal corneal ring segments (e.g., INTACS) may be considered medically necessary when provided in accordance with the Humanitarian Device Exemption (HDE) specifications of the U.S. Food and Drug Administration (FDA) for the treatment of patients with keratoconus who meet ALL of the following criteria:
- Who have experienced a progressive deterioration in their vision, such that they can no longer achieve adequate functional vision on a daily basis with their contact lenses or spectacles; and
- Who are 21 years of age or older; and
- Who have clear central corneas; and
- Who have a corneal thickness of 450 microns or greater at the proposed incision site; and
- Who have corneal transplantation as the only option remaining to improve their functional vision.
For all other indications, implantation of intrastromal corneal ring segments is considered not medically necessary.
Any pre- and post-operative evaluations and measurements [e.g., ophthalmic echography, keratometry, pachymetry, etc.] performed in conjunction withservices identifiedwith ineligible proceduresare non-covered.
Procedure Codes
65785
|
76510
|
76511
|
76512
|
76513
|
76514
|
76516
|
76519 |
Contact Lenses for Keratoconus
When a covered individual or group customer benefit, contact lenses are covered for the treatment of keratoconus.