CommercialAdministrativeLow impact
11.05.01g, Refractive Keratoplasty
Independence Blue Cross·Ophthalmology·Medical Policy
We identified it
Jun 19, 2026
Summary
Independence Blue Cross reissued medical policy 11.05.01h for Refractive Keratoplasty, Keratoprosthesis, and Corneal Collagen Cross-Linking as part of its annual review process on December 10, 2025. The policy maintains existing coverage criteria for medically necessary procedures (corneal relaxing incisions, corneal wedge resection, Boston KPro, and corneal collagen cross-linking epithelium-off) while continuing to classify epithelium-on cross-linking, alternative keratoprosthesis devices, and other refractive procedures as experimental/investigational and not covered.
Action Required
No immediate action required. This is an annual policy reissuance with no substantive coverage changes. Billing team should verify that current billing system rules continue to correctly implement the existing coverage criteria: (1) CPT 65772 and 65775 require documentation that astigmatism resulted from trauma or previous eye surgery; (2) CPT 65770 and C1818/L8609 (Boston KPro only) require documentation meeting all specified criteria including failed cadaveric transplants or very low likelihood of success, severe corneal opacity, best-corrected visual acuity thresholds, and qualifying indications; (3) CPT 0402T requires documentation of progressive keratoconus or corneal ectasia after refractive surgery; (4) CPT 65760, 65765, 65767, 65771, S0800, S0810, S0812, and epithelium-on cross-linking should continue to be denied as experimental/investigational. No system updates are needed unless the practice is still using version 11.05.01g—confirm all billing rules reference current version 11.05.01h.