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Endothelial Keratoplasty
Blue Cross & Blue Shield of Mississippi·MS · Ophthalmology·Medical Policy
We identified it
Jun 20, 2026
Summary
This policy establishes coverage criteria for endothelial keratoplasty procedures, declaring specific techniques as medically necessary for endothelial dysfunction while classifying laser-assisted variants as investigational. The policy provides clear guidelines for when these corneal transplant procedures are covered versus excluded.
Action Required
Immediately: Billing team must verify endothelial dysfunction is the primary cause before billing for endothelial keratoplasty procedures (Descemet stripping endothelial keratoplasty, Descemet stripping automated endothelial keratoplasty, Descemet membrane endothelial keratoplasty, or Descemet membrane automated endothelial keratoplasty). Do not bill femtosecond laser-assisted or femtosecond/excimer laser-assisted endothelial keratoplasty as these are considered investigational. Ensure documentation supports covered indications including endothelial dystrophy, bullous keratopathy, or previous transplant failure.