H18.601 Insurance Policy Changes

ICD-10 H18.601 is officially defined as "Keratoconus, unspecified, right eye." code H18.601 is referenced in 8 tracked payer policy changes from Blue Cross & Blue Shield of Mississippi and Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code H18.601 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Blue Cross & Blue Shield of Mississippi · Effective Jan 20, 2026Medium impact
Corneal Collagen Cross-Linking
Corneal collagen cross-linking using riboflavin and ultraviolet A may be considered medically necessary as a treatment of progressive keratoconus or corneal ectasia resulting from refractive surgery in individuals who have failed conservative treatment, such as spectacle correction or rigid contact lens. It is considered investigational for all other indications. Photrexa products are planned to be discontinued from the market effective January 20, 2026, with manufacturing set to end February 2026. Epioxa was approved in 2025 for treatment of keratoconus in adults and children aged 13 years and older.
Aetna · Identified Aug 15, 2026Medium impact
Corneal Pachymetry (CPB 0681, reviewed 2025-10-15)
Aetna considers ultrasound corneal pachymetry (CPT 76514) medically necessary for listed indications, including keratoconus, Fuchs' endothelial dystrophy, corneal edema, bullous keratopathy, corneal transplant and corneal refractive surgery evaluations, narrow angles, and glaucoma or glaucoma suspects, with the glaucoma indication covered once per lifetime. Repeat pachymetry for corneal diseases and injuries is not medically necessary if performed more frequently than once every 6 months. Screening for glaucoma without signs or symptoms, diagnosis of Marfan syndrome, pterygium management and monitoring on hydroxychloroquine are listed as experimental, investigational or unproven.
Aetna · Identified Aug 15, 2026Medium impact
Computerized Corneal Topography (CPB 0130, reviewed 2026-03-26)
Aetna considers computerized corneal topography medically necessary for central corneal ulcer, corneal dystrophy, bullous keratopathy, keratoconus or Terrien's marginal degeneration, difficult contact lens fitting, corneal ectasia, post-traumatic corneal scarring, irregular astigmatism before or after penetrating keratoplasty or kerato-refractive surgery, and pterygium or pseudopterygium. It is considered experimental, investigational, or unproven for pre-operative assessment of cataract patients and for a list of other conditions, including open-angle glaucoma, keratoconjunctivitis sicca, refractive errors, corneal hydrops, and lattice degeneration of the retina. Aetna does not cover computerized corneal topography performed before or after refractive eye surgery.
Aetna · Identified Aug 12, 2026Medium impact
Optical Coherence Tomography and Microelastography for Solid Tumors and Other Selected Indications (CPB 0886, reviewed 2026-03-03)
Aetna considers optical coherence tomography and microelastography experimental, investigational, or unproven for the listed intra-operative uses because their effectiveness has not been established. These uses include assessment of lymph nodes or tumor margins in breast conserving surgery, differentiation of pancreatic neoplastic lesions, differentiation of normal and diseased thyroid and parathyroid tissues, and solid tumor surgery including optical biopsy of lymph nodes and real-time determination of surgical margins. The policy lists CPT codes and ICD-10 codes as not covered for the indications it names.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Implantation of Intrastromal Corneal Ring Segments
Implantation of intrastromal corneal ring segments may be considered medically necessary for the treatment of keratoconus in patients 21 years of age or older who meet specific criteria. The procedure is considered not medically necessary as a treatment of myopia and investigational for all other conditions. For Federal Employee Program members, the policy notes that FDA-approved devices may be assessed only on the basis of medical necessity.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Gas Permeable Scleral Contact Lens
Blue Cross Blue Shield Association policy 9.03.25 (BCBSMS policy L.9.03.403) states that rigid gas permeable scleral lenses may be considered medically necessary for patients who have not responded to topical medications or standard spectacle or contact lens fitting. The listed conditions are corneal ectatic disorders, corneal scarring and/or vascularization, irregular corneal astigmatism, and ocular surface disease with pain and/or decreased visual acuity. Use of a rigid gas permeable scleral lens for any other condition is considered not medically necessary, and the most recent policy update dated 03/11/2026 removed ICD-9 diagnosis codes from the policy.
Aetna · Identified Nov 4, 2026Low impact
Microwave Thermotherapy (CPB 0682, reviewed 2026-10-26)
Aetna's Microwave Thermotherapy policy (CPB 0682) was reviewed on 2026-10-26, and the source does not state what changed or give a new effective date. It covers microwave thermotherapy as medically necessary only for T1 renal lesions, medically inoperable non-small cell lung cancer lesions under 3 cm, and hepatocellular carcinoma tumors of 3 cm or less, and it lists many other uses (such as breast, pancreatic, bladder, and chronic pain indications) as experimental, investigational or unproven.
Aetna · Identified Nov 3, 2026Low impact
Corneal Pachymetry (CPB 0681, reviewed 2026-10-26)
This is Aetna's clinical policy bulletin on ultrasound corneal pachymetry (corneal thickness measurement), CPB 0681, last reviewed October 26, 2026. It lists the indications where the test is considered medically necessary, the uses Aetna considers experimental, and a limit of one repeat test every six months for corneal diseases and injuries. The text does not describe a new rule with a stated effective date, so treat it as current policy language and confirm with Aetna before relying on it.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code H18.601?

There are 8 tracked policy changes affecting code H18.601, including updates from Blue Cross & Blue Shield of Mississippi, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code H18.601?

Payers that have issued tracked updates for code H18.601 include: Blue Cross & Blue Shield of Mississippi, Aetna.

How do I get notified when code H18.601 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code H18.601. You will get an email when new policy changes reference this code: daily or weekly, your choice, on every plan.

Why do payers change policies for code H18.601?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

All billing codes J3590 C9399 J3490 99215 99213 99202

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Corneal Collagen Cross-Linking

Corneal Pachymetry (CPB 0681, reviewed 2025-10-15)

Computerized Corneal Topography (CPB 0130, reviewed 2026-03-26)

Optical Coherence Tomography and Microelastography for Solid Tumors and Other Selected Indications (CPB 0886, reviewed 2026-03-03)

Implantation of Intrastromal Corneal Ring Segments

Gas Permeable Scleral Contact Lens

Microwave Thermotherapy (CPB 0682, reviewed 2026-10-26)

Corneal Pachymetry (CPB 0681, reviewed 2026-10-26)

What insurance policy changes affect code H18.601?

Which payers have updated policy for code H18.601?

How do I get notified when code H18.601 policy changes?

Why do payers change policies for code H18.601?