Medicare Reimbursement for Corneal Topography

While keratometry provides a measure of corneal curvature with special attention to asphericity and astigmatism, corneal topography (CT) provides the eye care professional with a precise map in minute detail of the configuration of the corneal surface. 

CT is used for the diagnosis and management of corneal disease, disorders, ab-normalities, or injury.  It is helpful as an adjunct to contact lens fitting, particularly in difficult cases such as keratoconus.  Prior to refractive surgery, CT is an important test that helps the surgeon plan the procedure.  Following corneal surgery, CT is invaluable for postoperative management, including planning surgical enhancement, wound revision and suture removal. 

CT is also valuable prior to cataract surgery and concurrent refractive surgery, such as keratotomy (e.g., limbal relaxing incisions) or keratoplasty. In the case where the surgeon plans to insert a toric intraocular lens (IOL), CT helps determine the proper alignment for the lens to reduce astigmatism.

Not all indications are covered by Medicare or other third-party payers.  Some MACs have published indications for CT as well as lists of covered diagnoses.  Differences in payment policies exist for many payers.

This monograph discusses reimbursement for CT.  Much of the information is taken from official publications of CMS and it’s Medicare Administrative Contractors (MACs); however, the reader is encouraged to check with the local MAC for additional information and instructions.  In the case of other third party payers, we have used the coding concepts contained in CPT and published by the American Medical Association; diagnosis codes are from ICD-9-CM.  Documentation of the procedure is a key part of reimbursement, so we describe the required elements in detail. 

Since economic analyses are a necessary part of any capital budgeting decision, we incorporated Medicare’s utilization and payment rates for the test.

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