Endothelial cell photography involves the use of a specular microscope to determine the endothelial cell count. It is used by ophthalmologists as a predictor of success of ocular surgery or certain other ocular procedures.

Endothelial cell photography is a covered procedure under Medicare when reasonable and necessary for patients who meet one or more of the following criteria:

• Have slit lamp evidence of endothelial dystrophy (cornea guttata),
• Have slit lamp evidence of corneal edema (unilateral or bilateral),
• Are about to undergo a secondary intraocular lens implantation,
• Have had previous intraocular surgery and require cataract surgery,
• Are about to undergo a surgical procedure associated with a higher risk to corneal endothelium; i.e., phacoemulsification, or refractive surgery (see §80.7 for excluded refractive procedures),
• With evidence of posterior polymorphous dystrophy of the cornea or irido-corneal-endothelium syndrome, or
• Are about to be fitted with extended wear contact lenses after intraocular surgery.

When a pre-surgical examination for cataract surgery is performed and the conditions of this section are met, if the only visual problem is cataracts, endothelial cell photography is covered as part of the presurgical comprehensive eye examination or combination brief/intermediate examination provided prior to cataract surgery, and not in addition to it. (See §10.1.)