Corneal Topography/Computer-Assisted Corneal Topography/Photokeratoscopy

POLICY NUMBER

L.9.03.408

DESCRIPTION

Computer-assistedcorneal topography (also called photokeratoscopy or videokeratography) provides a quantitative measure of corneal curvature. Measurement of corneal topography is being evaluated to aid the diagnosis of and follow-up for corneal disorders such as keratoconus, difficult contact lens fits, and pre- and postoperative assessment of the cornea, most commonly after refractive surgery.

Detection and Monitoring Diseases of the Cornea

Corneal topography describes measurements of the curvature of the cornea. An evaluation of corneal topography is necessary for the accurate diagnosis and follow-up of certain corneal disorders, such as keratoconus, difficult contact lens fits, and pre- and postoperative assessment of the cornea, most commonly after refractive surgery.

Assessing corneal topography is part of the standard ophthalmologic examination of some patients. Corneal topography can be evaluated and determined in multiple ways. Computer-assisted corneal topography has been used for early identification and quantitative documentation of the progression of keratoconic corneas, and evidence is sufficient to indicate that computer-assisted topographic mapping can detect and monitor disease.

Various techniques and instruments are available to measure corneal topography: keratometer, keratoscope, and computer-assisted photokeratoscopy.

A number of corneal topography devices have been cleared for marketing by the U.S. Food and Drug Administration (FDA) through the 510(k) process. In 1999, the Orbscan® (manufactured by Orbtek, distributed by Bausch and Lomb) was cleared by the FDA. The second generation Orbscan II is a hybrid system that uses both projective (slit scanning) and reflective (Placido) methods. The Pentacam® (Oculus) is one of a number of rotating Scheimpflug imaging systems produced in Germany. In 2005, the Pentacam HR was released with a newly designed high-resolution camera and improved optics.

Corneal Topography Devices Cleared by the U.S. Food and Drug Administration

POLICY

Non-computer-assisted corneal topography is considered part of the evaluation and management services of general ophthalmological services (CPT codes 92002-92014), and therefore this service should not be billed separately. There is no separate CPT code for this type of corneal topography. 

Computer-assisted corneal topography is considered investigational to detect or monitor diseases of the cornea.

POLICY EXCEPTIONS

Federal Employee Program (FEP) may dictate that all FDA-approved devices, drugs or biologics may not be considered investigational and thus these devices may be assessed only on the basis of their medical necessity.

POLICY GUIDELINES

The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.

Non-computer-assisted corneal topography should be considered inclusive to evaluation and management services.

Investigative is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized as a generally accepted standard of good medical practice for the treatment of the condition being treated and; therefore, is not considered medically necessary. For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of medical practitioners practicing in relevant clinical areas and any other relevant factors. In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting.

POLICY HISTORY

12/19/2006: Policy added.

3/5/2007: Code Reference section updated per quarterly HCPCS revisions.

3/22/2007: Reviewed and approved by the Medical Policy Advisory Committee (MPAC).

1/10/2008: Policy reviewed, no changes.

4/24/2009: Policy reviewed, policy statement changed from investigational to not medically necessary.

04/28/2010: Policy description and statement unchanged. FEP verbiage added to the Policy Exceptions section.

06/22/2011: Policy reviewed; no changes.

05/09/2012: Policy reviewed; no changes.

05/08/2013: Policy reviewed; no changes to policy statement. Removed deleted HCPCS code S0820 from the Code Reference section.

07/01/2014: Policy reviewed; description updated. Policy statement unchanged.

07/13/2015: Code Reference section updated for ICD-10.

09/16/2015: Policy description updated regarding devices. Policy statements unchanged.

04/22/2016: Policy title changed from "Corneal Topography/Computer-Assisted Photokeratoscopy" to "Corneal Topography/Computer-Assisted Corneal Topography/Photokeratoscopy." Policy description updated. Policy statements unchanged.

05/27/2016: Policy number A.9.03.05 added.

03/29/2017: Policy title updated to change "Corneal Topography/Computer-Assisted Photokeratoscopy" to "Corneal Topography/Computer-Assisted Corneal Topography/Photokeratoscopy." Policy description updated regarding detecting and monitoring diseases of the cornea. Policy statements unchanged. Policy guidelines updated to add investigative definition.

04/10/2018: Policy reviewed; no changes.

04/08/2019: Policy reviewed; no changes.

04/16/2020: Policy description updated regarding devices. Policy statements unchanged.

05/27/2021: Policy reviewed; no changes.

05/19/2022: Policy reviewed; no changes.

04/18/2023: Policy description updated regarding devices. Policy statement updated to change "not medically necessary" to "investigational."

04/26/2024: Policy description updated regarding devices. Policy statements unchanged.

07/26/2024: Policy updated to change the medical policy number from "A.9.03.05" to "L.9.03.408."

SOURCE(S)

Blue Cross Blue Shield Association Policy # 9.03.05 

CODE REFERENCE

This may not be comprehensive list of procedure codes applicable to this policy.

Investigational Codes

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