Aetna Commercial Clinical Policy

Aetna Endothelial Cell Photography Form

Effective Date

06/29/2001

Last Reviewed

07/21/2023

Original Document

  Reference



Background for this Policy

Endothelial cell photography (also known as specular endothelial microscopy, anterior segment photography, and corneal endothelial microscopy) involves the use of a specular microscope to determine the endothelial cell count. It is used by ophthalmologists to predict success of ocular surgery and other ocular procedures.

Scope of Policy

This Clinical Policy Bulletin addresses endothelial cell photography.

Medical Necessity

Aetna considers endothelial cell photography medically necessary for members with

any

of the following indications:

  • Are about to be fitted with extended wear contact lenses after intraocular surgery;
    • or
  • Are about to undergo a secondary intraocular lens implantation;
    • or
  • Are about to undergo a surgical procedure associated with a higher risk to corneal endothelium;
    • or
  • Have had previous intraocular surgery and require cataract surgery;
    • or
  • Have slit-lamp evidence of corneal edema (unilateral or bilateral);
    • or
  • Have slit-lamp evidence of endothelial dystrophy (corneal guttata, i.e., Fuch's dystrophy);
    • or
  • With evidence of posterior polymorphous dystrophy of the cornea or irido-corneal endothelium syndrome.

    • Experimental and Investigational

    Aetna considers endothelial cell photography experimental and investigational for other indications because it has no proven clinical value for other indications.

    Policy Limitations and Exclusions

    Note: Endothelial cell photography is considered an integral part of the pre-surgical comprehensive or brief/intermediate eye examination when done prior to cataract surgery when the member's only visual problem is cataracts. This is true regardless of the type of cataract technique utilized (including phaco-emulsification).