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Keratoprosthesis
Blue Cross & Blue Shield of Mississippi·MS · Ophthalmology·Medical Policy
We identified it
Jun 20, 2026
Summary
This policy establishes medical necessity criteria for keratoprosthesis (artificial cornea) procedures. The Boston Keratoprosthesis is covered for severe corneal opacification when corneal transplants have failed or are unlikely to succeed, with specific visual acuity and clinical requirements. All other permanent keratoprostheses remain investigational.
Action Required
Immediately: Billing team should review keratoprosthesis claims to ensure they meet the specific medical necessity criteria outlined in the policy. Verify patients have visual acuity of 20/400 or less in affected eye, 20/40 or less in contralateral eye, and qualifying conditions like failed transplants or Stevens-Johnson syndrome. Only Boston Keratoprosthesis procedures should be billed as medically necessary; all other keratoprosthesis types should be flagged as investigational.