All PlansCoverageMedium impact
Corneal Collagen Cross-Linking
BCBS Tennessee·Ophthalmology·Medical Policy
Effective date
Jun 30, 2026
We identified it
Jun 17, 2026
Summary
New policy establishes coverage criteria for corneal collagen cross-linking (CXL) for progressive keratoconus and corneal ectasia, requiring failure of conservative treatment and use of FDA-approved products like Photrexa or Epioxa. The policy becomes effective June 30, 2026, with Photrexa products being withdrawn from market in early 2026.
Action Required
By June 30, 2026: Billing team must implement new medical appropriateness criteria for corneal collagen cross-linking procedures. Update prior authorization requests to document progressive keratoconus or corneal ectasia diagnosis, failure of conservative treatment (spectacles/contact lenses), and use of approved products (Photrexa or Epioxa for patients 13+). Train staff on new coverage requirements as claims not meeting all criteria will be denied.