What is corneal collagen coss-linking for keratoconus?
Corneal collagen cross-linking is a treatment for keratoconus. In corneal coss-linking, doctors use eyedrop medication and ultraviolet (UV) light from a special machine to strengthen the tissues in your cornea. The procedure involves applying specially formulated riboflavin (vitamin B2) eyedrops to your cornea, which allow it to better absorb light. After about 30 minutes, you’ll look up at a light while lying back in a chair. The entire treatment takes about 60-90 minutes.
The procedure doesn’t reverse cornea changes that have already happened – it just keeps them from getting worse. Since it can help slow progression, it’s best to talk to your doctor sooner than later if you have keratoconus.
How much does Crosslinking for Keratoconus cost?
There is limited evidence on the costs of corneal crosslinking, but it may be as high as $2,500 to $4,000 per eye in the United States. a cost-effectiveness study estimated the costs of the total treatment for one person as £928 in the UK National Health Service.
Is crosslinkig for keratoconus covered by health insurance?
Since FDA approval of corneal collagen crosslinking (CXL) for keratoconus in April 2016, many insurance companies have started covering this procedure for progressive keratoconus and keratectasia.
Where in the United States is crosslinkig for keratoconus covered by health insurance?
All 50 states have six or more health insurance plans that cover the FDA-approved corneal cross-linking for keratoconus.
Which corneal crosslinking method is covered?
FDA has approved corneal collagen crosslinking (CXL) for progressive keratoconus in April 2016. this approval only covers the crosslinking products developed by Glaukos Corporation (formerly Avedro, Inc.).
This FDA-approved method involves corneal epithelial debridment, hence it is known as epithelium-off or epi-off crosslinking. At this time, epi-on crosslinking method is not approved by FDA and thus it is not covered.
What are the drugs and devices used in the FDA-approved corneal cross-linking?
FDA-approved corneal cross-linking uses the drugs and device manufactured by Avedro. In order to be eligible for insurance reimbursement, your procedure must consist of the KXL System and Photrexa drug formulations. These are the only cross-linking drugs and device that are FDA-approved and eligible for insurance reimbursement in the United States.
What is the CPT code for corneal collagen crosslinking?
Category III CPT 0402T: Collagen crosslinking of cornea, including removal of the corneal epithelium and intraoperative pachymetry when performed.
CPT Category III codes represent temporary codes for new and emerging technologies. They have been created to allow for data collection and utilization tracking for new procedures or services. With this Category III code the individual payers will decide whether to cover the procedure.
Does Photrexa® Viscous and Photrexa® have product specific J-code?
J-code J2787 has been issued by the Centers for Medicare and Medicaid Services for the use of Photrexa® Viscous (riboflavin 5’-phosphate in 20% dextran ophthalmic solution) and Photrexa® (riboflavin 5’-phosphate ophthalmic solution) formulas.
Below is an updated list of insurance companies in United States that cover corneal collagen crosslinking (CXL) for progressive keratoconus:
| Payer Name | Payer Region | |
|---|---|---|
| Aetna | National | |
| AllWays Health Partners | MA | |
| AmeriHealth | DE, NJ, PA | |
| Anthem | National | |
| Arkansas Blue Cross Blue Shield | AR | |
| BCBS Health Advantage | AR | |
| BCBS of North Dakota | ND | |
| BCBS of Vermont | VT | |
| Blue Cross Blue Shield FEP | National | |
| Blue Cross Blue Shield of Alabama | AL | |
| Blue Cross Blue Shield of Arizona | AZ | |
| Blue Cross Blue Shield of Florida | FL | |
| Blue Cross Blue Shield of Georgia | GA | |
| Blue Cross Blue Shield of Illinois | IL | |
| Blue Cross Blue Shield of Kansas | KS | |
| Blue Cross Blue Shield of Kansas City | Kansas City, Northwestern MO, Johnson & Wyandotte Counties | |
| Blue Cross Blue Shield of Louisiana | LA | |
| Blue Cross Blue Shield of Massachusetts | MA | |
| Blue Cross Blue Shield of Michigan | MI | |
| Blue Cross Blue Shield of Minnesota | MN | |
| Blue Cross Blue Sheild of Mississippi | MS | |
| Blue Cross Blue Shield of Montana | MT | |
| Blue Cross Blue Shield of New Mexico | NM | |
| Blue Cross Blue Shield of North Carolina | NC | |
| Blue Cross Blue Shield of North Dakota | ND | |
| Blue Cross Blue Shield of Oklahoma | OK | |
| Blue Cross Blue Shield of Rhode Island | RI, CT, MA | |
| Blue Cross Blue Shield of South Carolina | SC | |
| Blue Cross Blue Shield of Tennessee | TN | |
| Blue Cross Blue Shield of Texas | TX | |
| Blue Cross and Blue Shield of Vermont | VT | |
| Blue Cross of Idaho | ID | |
| Blue Shield of California | CA | |
| BlueChoice Health Plan of South Carolina | SC | |
| Capital Blue Cross | Central PA | |
| Capital Health Plan | FL | |
| CareFirst Blue Cross Blue Shield | MD, DC, Northern VA | |
| Cigna Health | National | |
| ConnectiCare | CT | |
| Dean Health Plan | WI | |
| Emblem Health | NY | |
| Empire Blue Cross Blue Shield | NY | |
| Fallon Health | MA | |
| Geisinger Health | PA, DE, ME, NJ, WV | |
| Harvard Pilgrim | MA | |
| Hawaii Medical Service Association | HI | |
| Health Alliance Plan of Michigan | MI | |
| Health New England | MA | |
| HealthNet | CA, AZ | |
| HealthPartners Minnesota | MN, ND, SD, WI | |
| Highmark Blue Shield | DE, PA, WV | |
| Horizon Blue Cross of New Jersey | NJ | |
| Humana | National | |
| Independence Blue Cross | PA, NJ, DE, MD | |
| John Hopkins HealthCare | MD | |
| Kaiser Permanente | AZ, CA, CO, DC, GA, HI, MD, NV, TX, VA, WA | |
| Medica Health Plans | MN, WI, ND, SD | |
| Medical Mutual | OH | |
| Moda Health | OR | |
| Nebraska Blue | NE | |
| Premera Blue Cross | WA, OR, AK | |
| Presbyterian Health | NM, AZ, CO, TX | |
| Priority Health of Michigan | MI | |
| Providence Health Plan | OR, WA | |
| Public Employee Health Plan (PEHP) | UT | |
| Quartz - Unity Health | WI | |
| Regence Blue Cross Blue Shield | ID, OR, UT, WA | |
| Rocky Mountain Health Plans | CO, NE | |
| Scott & White Health Plan (SWHP) | TX | |
| Select Health | ID, UT | |
| Tricare | TRICARE Policy Manual: Rare Diseases, Eye And Ocular Adnexa, Available to all Tricare beneficiaries, including dependents. also see this comment. | |
| Tufts Health Plan | MA, RI | |
| United Healthcare | National | |
| Wellmark Blue Cross and Blue Shield | IA, SD | |
| This list is subject to change. It is not intended to be a directive, nor is it a suggestion about the likelihood of coverage or reimbursement. Please confirm with your individual carriers. | ||
Reimbursement questions and financial assistance
The iPath360 program by Glaukos is a service to help keratoconus patients with reimbursement questions, prescription assistance and the possibility of financial assistance for eligible patients.
Call the iPath360 hotline 844-528-3311 for questions about coding, billing, claims submissions or payer coverage for corneal cross-linking with Photrexa® Viscous and Photrexa® with the KXL® System.
Visit iPath360's website and Avedro's website to learn more about insurance coverage and find resources and cornea specialist who perform corneal crosslinking.