Reimbursement for Femtosecond Laser-Assisted Keratoplasty

Femtosecond (FS) laser-assisted keratoplasty is a form of keratoplasty that uses a FS laser to create incisions for certain types of corneal transplantation. The FS laser can be used on the donor tissue, recipient, or both. The FS laser enables the surgeon to create complex shaped incisions, such as “top hat” or “zigzag”, so the recipient and transplant tissue may be accurately fitted together like an intricate puzzle. The result is a potentially stronger graft.1

In contrast, traditional penetrating keratoplasty (PK) uses a handheld, bladed “cookie cutter” called a trephine to make a full- or partial-thickness, vertical, and circular, incision. There are often difficulties in having the corneal walls remain perfectly vertical. Using a separate trephine, a plug-shaped tissue graft is prepared from donor cornea. With trephine preparation, the transplanted tissue graft is placed into the space; it requires suturing to maintain its position. The sutures stay in the eye for a year or longer. Patients generally do not achieve full visual recovery for a prolonged period of time, due to slow healing and subsequent changes in corneal curvature and astigmatism.


This FAQ addresses the following:

  1. What is femtosecond laser-assisted keratoplasty?
  2. What are the indications for FS laser use with keratoplasty?
  3. How should the use of the FS laser be documented in the medical record?
  4. What CPT codes best describe FS laser-assisted keratoplasty?
  5. What is the significance of +0290T having Category III status?
  6. What is the Medicare reimbursement for add-on code +0290T?
  7. May we collect a separate fee for the add-on code if the patient agrees?

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