Medicare AdvantageCoverageMedium impact
MA11.008g, Refractive Keratoplasty, Keratoprosthesis, and Corneal Collagen Cross-Linking
Independence Blue Cross·Ophthalmology·Medical Policy
Effective date
Jul 27, 2026
We identified it
Jul 28, 2026
Summary
Independence Blue Cross MA11.008g expands coverage to include keratoprosthesis and corneal collagen cross-linking procedures. The policy now covers corneal collagen cross-linking epithelium-off for progressive keratoconus and corneal ectasia following refractive surgery, but explicitly excludes epithelium-on procedures as experimental/investigational. Billing teams must update systems to distinguish between covered epithelium-off and non-covered epithelium-on cross-linking procedures.
Action Required
By July 27, 2026: (1) Billing team must update claim submission system to recognize and process CPT 0402T (epithelium-off collagen cross-linking) as medically necessary with appropriate diagnosis codes for progressive keratoconus or corneal ectasia post-refractive surgery. (2) Configure system to deny claims for epithelium-on cross-linking procedures as experimental/investigational. (3) Update encounter forms and prior authorization templates to include fields specifying epithelium-off vs. epithelium-on procedure type. (4) Providers must document whether procedure is epithelium-off or epithelium-on and confirm medical indication (keratoconus vs. corneal ectasia). (5) Ensure CPT 65760, 65765, 65767, 65771 and HCPCS S0800, S0810 remain configured as not covered. (6) Continue processing CPT 65770, HCPCS C1818 and L8609 for Boston KPro when criteria are met. Claims for epithelium-on procedures or LASIK/PRK codes will be denied without proper documentation and coding.