CG-SURG-72 Endothelial Keratoplasty

This policy addresses endothelial keratoplasty procedures (DMEK, DSEK, DSAEK, DMAEK) for partial-thickness corneal transplantation. These procedures are covered as medically necessary for corneal endothelial disorders, including Fuchs’ endothelial dystrophy, aphakic/pseudophakic bullous keratopathy after cataract surgery, and failure or rejection of a prior corneal transplant. They are not covered for corneal stromal diseases or injuries (e.g., keratoconus, infectious corneal ulcers, traumatic injuries), and femtosecond laser–assisted EK (FLEK/FELEK) is not medically necessary for any indication.

"The use of DMEK, DSEK, DSAEK and DMAEK, is consideredmedically necessaryfor the treatment of disorders of the corneal endothelium, including but not limited to the following:"

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