Summary Of Evidence

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Analysis of Evidence

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History/Background and/or General Information

Computerized Corneal Topography (also known as computer-assisted video keratography [CAVK]) and corneal mapping is a computer assisted diagnostic imaging technique in which 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 accurate portrayal of the physical state of the cornea and the subtle detection of corneal surface irregularity and astigmatism.

Please refer to CMS IOM Publication 100-03, Medicare National Coverage Determinations (NCD) Manual, Chapter 1, Part 1, Section 80.7 and Section 80.7.1 for guidelines regarding keratoplasty.

Covered Indications

Computerized Corneal Topography will be considered medically necessary under any of the following conditions:

• pre-operatively for evaluation of irregular astigmatism prior to cataract surgery
• monocular diplopia
• bullous keratopathy
• post surgical or post traumatic astigmatism, measuring at a minimum of 3.5 diopters;
• post penetrating keratoplasty surgery;
• post surgical or post traumatic irregular astigmatism;
• corneal dystrophy;
• complications of transplanted cornea;
• post traumatic corneal scarring;
• keratoconus; 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.

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 non-covered procedure, i.e., radial keratotomy. 

As published in the CMS IOM Publication 100-08, Medicare Program Integrity Manual, Chapter 13, Section 13.5.4, an item or service may be covered by a contractor LCD if it is reasonable and necessary under the Social Security Act Section 1862 (a)(1)(A). Contractors shall determine and describe the circumstances under which the item or service is considered reasonable and necessary.