T85.398S Insurance Policy Changes

ICD-10 T85.398S is officially defined as "Other mechanical complication of other ocular prosthetic devices, implants and grafts, sequela." code T85.398S is referenced in 3 tracked payer policy changes from Aetna and Blue Cross & Blue Shield of Mississippi. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code T85.398S is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

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.
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.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Endothelial Keratoplasty
Blue Cross Blue Shield Association policy 9.03.22, now listed as BCBSMS policy L.9.03.412, states that endothelial keratoplasty (Descemet stripping endothelial keratoplasty, Descemet stripping automated endothelial keratoplasty, Descemet membrane endothelial keratoplasty, or Descemet membrane automated endothelial keratoplasty) may be considered medically necessary for endothelial dysfunction, including ruptures in Descemet membrane, endothelial dystrophy, aphakic and pseudophakic bullous keratopathy, iridocorneal endothelial syndrome, corneal edema attributed to endothelial failure, and failure or rejection of a previous corneal transplant. Femtosecond laser-assisted endothelial keratoplasty and femtosecond and excimer laser-assisted endothelial keratoplasty are considered investigational, and endothelial keratoplasty is considered investigational when endothelial dysfunction is not the primary cause of decreased corneal clarity. The most recent policy update, dated 03/11/2026, removed ICD-9 diagnosis codes from the policy.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code T85.398S?

There are 3 tracked policy changes affecting code T85.398S, including updates from Aetna, Blue Cross & Blue Shield of Mississippi. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code T85.398S?

Payers that have issued tracked updates for code T85.398S include: Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when code T85.398S policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code T85.398S. 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 T85.398S?

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

Gas Permeable Scleral Contact Lens

Endothelial Keratoplasty

What insurance policy changes affect code T85.398S?

Which payers have updated policy for code T85.398S?

How do I get notified when code T85.398S policy changes?

Why do payers change policies for code T85.398S?