CG-SURG-105 Corneal Collagen Cross-Linking

This policy addresses corneal collagen cross-linking (CXL) for keratoconus. CXL is medically necessary to treat progressive keratoconus when the diagnosis is confirmed by keratometry and corneal mapping and progression is documented within 24 months by any of the following: an increase ≥1.0 D in steepest keratometry, an increase ≥1.0 D in manifest cylinder, or an increase ≥0.50 D in MRSE; it is not medically necessary when these criteria are not met or for any other indications. Coverage is limited to cases meeting all criteria for documented progression.

"Corneal collagen cross-linking (CXL) is consideredmedically necessaryas a treatment for progressive keratoconus when all of the following conditions are met:"

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