Corneal Remodeling

Aetna covers corneal relaxing incisions or corneal wedge resection for surgically induced astigmatism only if the member had penetrating keratoplasty within 60 months or cataract surgery within 36 months, has ≥3.00 D of astigmatism, and is intolerant of glasses/contacts; PTK is medically necessary for corneal scars/opacities, epithelial membrane dystrophy, Salzmann’s/keratoconus nodules, and recurrent corneal erosions after failed conservative therapy but is investigational for infectious keratitis and other unlisted indications. Refractive procedures (e.g., RK, AK, PRK, LASIK, intrastromal ring segments) are excluded under standard plans or deemed experimental/not medically necessary unless the plan explicitly covers refractive surgery.

"Appropriate ICD-10 diagnosis code(s) corresponding to a covered indication must be submitted with the procedural code(s)."

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