Medicare AdvantageCoverageMedium impact
MA11.008f, Refractive Keratoplasty
Independence Blue Cross·Ophthalmology·Medical Policy
Effective date
Dec 29, 2025
We identified it
Jun 19, 2026
Summary
Independence Blue Cross updated policy MA11.008f to MA11.008g, effective 12/29/2025, reclassifying corneal collagen cross-linking (CPT 0402T) from Experimental/Investigational to Medically Necessary for treating progressive keratoconus and corneal ectasia following refractive surgery. Billing teams must update systems to process claims for CPT 0402T without investigational denials starting on the effective date.
Action Required
By December 29, 2025: (1) Billing team must update billing system to reclassify CPT 0402T from investigational/experimental to medically necessary status in the IBX Medicare Advantage claims processing rules. (2) Remove any automated denials or investigational holds previously applied to CPT 0402T claims. (3) Update provider communication materials and prior authorization guidelines to reflect that corneal collagen cross-linking is now covered for progressive keratoconus and corneal ectasia post-refractive surgery. (4) Providers should ensure claims submitted on or after 12/29/2025 for CPT 0402T include appropriate ICD-10 diagnosis codes supporting medical necessity (progressive keratoconus or post-refractive corneal ectasia). Claims submitted before this date with CPT 0402T may still be denied as investigational; ensure rebilling after the effective date. Failure to update system rules will result in unnecessary claim denials and delayed payments.