Refractive and Therapeutic Keratoplasty

This policy covers refractive and therapeutic keratoplasty and related corneal surgeries — including lamellar/non‑penetrating and penetrating keratoplasty, phototherapeutic keratectomy, and other procedures to remove, add, or reshape corneal tissue. It applies to patients with corneal scarring, edema or thinning, dystrophies (e.g., Fuchs), keratoconus, bullous keratopathy, severe infectious or traumatic ulcers, descemetocele, childhood aphakia, and similar disease states, but excludes or deems not medically necessary procedures performed primarily for refractive correction (examples: LASIK, many keratomileusis/ALK techniques, SMILE, RK and other listed refractive procedures); coverage may also be subject to member benefit plan language and the policy is noted as inactive for current claims adjudication.

"Lamellar or non-penetrating keratoplasty for corneal scarring, edema, thinning, distortion, dystrophy, degeneration, or keratoconus."