Harvard Pilgrim is updating our commercial Vision Surgeries for Refractive Errors Medical Policy, effective immediately, to allow coverage for corneal collagen cross-linking. Harvard Pilgrim considers this procedure medically necessary for the treatment of progressive keratoconus and corneal ectasia following refractive surgery when conservative treatment has been tried without success and when documentation confirms either of the following:
- A diagnosis of progressive keratoconus supported by any of the following changes in a twenty-four-month period:
- An increase of at least one diopter (in either the manifest cylinder or steepest keratotomy measurement)
- An increase of at least half a diopter in manifest refraction spherical equivalent
- A diagnosis of corneal ectasia following refractive surgery supported by all of the following: consistent axial topography pattern, including relative inferior steepening with inferior-superior difference of at least 1.5 diopters; corrected distance visual acuity worse than 20/20, and corneal thickness of at least three hundred micrometers at the thinnest area
Prior authorization is not required. To receive reimbursement for corneal collagen cross-linking, please use the following covered CPT code:
- 66999 – Unlisted procedure, anterior segment of eye [when specified as laser epithelial keratomileusis (LASEK) or photoastigmatic keratectomy (PRK-A)].
For more information, refer to Harvard Pilgrim’s updated Vision Surgeries for Refractive Errors Medical Policy.