Summary Of Evidence

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Analysis of Evidence

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Abstract:

Corneal topography is a computer assisted diagnostic technique where a special instrument projects a series of light rings on the cornea, creating a color coded map of the corneal surface as well as a cross-section profile. This service is used to provide a detailed map or chart of the physical features and shape of the anterior surface of the cornea. This permits a more nearly accurate portrayal of the physical state of the cornea and for the detection of subtle corneal surface irregularity and astigmatism.



 Indications:

Computerized corneal topography is considered medically necessary under any of the following conditions:

• pre-operative evaluation of irregular astigmatism for intraocular lens power determination with cataract surgery;
• monocular diplopia;
• diagnosis of early keratoconus;
• post-surgical or post-traumatic astigmatism, measuring at a minimum of 3.5 diopters;
• suspected irregular astigmatism based on retinoscopic streak or conventional keratometry;
• post-penetrating keratoplasty surgery;
• post-surgical or post-traumatic irregular astigmatism;
• certain corneal dystrophies;
• complications of transplanted cornea;
• post-traumatic corneal scarring; and/or
• pterygium and/or corneal ectasia that cause visual impairment.

Limitations:

Corneal topography will only be allowed for a pre-operative cataract patient if documentation supports that the patient has irregular astigmatism. Its use for this purpose should be rare.

Corneal topography is to be billed only when the diagnosis of monocular diplopia is thought to be caused by a corneal irregularity.

Corneal topography is a covered service for the above indications when medically reasonable and necessary only if the results will assist in defining further treatment. It is not covered for routine follow-up testing.

Repeat testing is only indicated if a change of vision is reported in connection with one of the above listed conditions.

Services performed for screening purposes or in the absence of associated signs, symptoms, illness or injury as indicated above, will be denied as non-covered.

Corneal topography will be non-covered if performed pre- or post-operatively in relation to a Medicare non-covered procedure, e.g., radial keratotomy. 



Other Comments:

For claims submitted to the Part A MAC: this coverage determination also applies within states outside the primary geographic jurisdiction with facilities that have nominated CGS Administrators, LLC. to process their claims.


Limitation of liability and refund requirements apply when denials are likely, whether based on medical necessity or other coverage reasons. The provider/supplier must notify the beneficiary in writing, prior to rendering the service, if the provider/supplier is aware that the test, item or procedure may not be covered by Medicare. The limitation of liability and refund requirements do not apply when the test, item or procedure is statutorily excluded, has no Medicare benefit category or is rendered for screening purposes.