Aetna anterior segment imaging Coverage Update

Coverage Summary

policy_number: 0749; subject: Anterior segment scanning computerized ophthalmic diagnostic imaging (AS-OCT, Pentacam, SLO, SLP); status: CURRENT; effective date: 2008-03-21; next review date: 2024-08-08.

scope_summary: Defines Aetna's coverage stance on anterior segment scanning computerized ophthalmic diagnostic imaging modalities (including anterior segment OCT, Pentacam, SLO, and SLP), lists indications considered experimental/investigational, policy limitations/exclusions, related codes, and background evidence summary for anterior segment imaging.

coverage_stance: mixed — primary coverage stance group classified as experimental/investigational for many AS-OCT and other anterior segment imaging indications, while some uses are described as promising but without demonstrated improved outcomes.

Key policy facts

Primary coverage stance groupExperimental / Investigational

Specific CPT listed92132 (Scanning computerized ophthalmic diagnostic imaging, anterior segment, with interpretation and report)

Example experimental indications (count)24 listed indications (eg, assessment of Haab striae; detection of glaucoma; evaluation of conjunctival tumors; quantification of corneal haziness)

Evidence Items SummarizedMultiple study types summarized (case reports, case series, prospective studies, systematic reviews) — diagnostic accuracy, reproducibility, feasibility and imaging comparisons

Effective date2008-03-21

Last review2023-10-06

Next review2024-08-08

Medical Necessity / Experimental Determinations

Experimental and Investigational

The following interventions are considered experimental and investigational because the effectiveness of these approaches has not been established:

ALL of the following

Anterior segment OCT for all indications (including, but not limited to)
- Assessment of Haab striae
- Characterization of the ocular surface changes associated with ocular graft-versus-host disease
- Detection of glaucoma
- Diagnosis of Descemet membrane detachment during cataract surgery

Coding

Primary CPT code referenced in policyCPT

92132

Scanning computerized ophthalmic diagnostic imaging, anterior segment, with interpretation and report, unilateral or bilateral.

Other related CPT codes (context)CPT

65760	Keratomileusis.
65765	Keratophakia.
65767	Epikeratoplasty.
65770	Keratoprostesis.
65771	Radial keratotomy.
66170	Fistulization of sclera for glaucoma; trabeculectomy ab externo in absence of previous surgery.
66982	Extracapsular cataract removal with insertion of intraocular lens prosthesis, complex.
66983	Intracapsular cataract extraction with insertion of intraocular lens prosthesis.
66984	Extracapsular cataract removal with insertion of intraocular lens prosthesis.

Related HCPCS / J / S codesHCPCS|J|S

J9037	Injection, belantamab mafodontin-blmf, 0.5 mg.
S0596	Phakic intraocular lens for correction of refractive error.
S0800	Laser in situ keratomileusis (LASIK).
S0810	Photorefractive keratectomy.

ICD-10 codes cited as not covered for indications listed in the CPB (not all-inclusive)ICD-10Not Covered

B48.8-B49	Other specified and unspecified mycoses.
C69.00-C69.02	Malignant neoplasm of conjunctiva.
C69.10-C69.12	Malignant neoplasm of cornea.
D31.10-D31.12	Benign neoplasm of cornea.
D36.0	Benign neoplasm of lymph nodes [benign reactive lymphoid hyperplasia].
D89.810-D89.813	Graft-versus-host disease [ocular].
E83.01	Wilson's disease.
E85.9	Amyloidosis, unspecified [conjunctival amyloidosis].
H11.431-H11.439	Conjunctival hyperemia.
H16.101-H16.109	Unspecified superficial keratitis [associated with belantamab].

1–10 of 21

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Provider Actions & Billing Guidance

Documentation Required

Refractive surgery-associated imaging not covered if surgery not covered

Do not bill for Pentacam anterior segment imaging when it is performed for indications related to refractive eye surgery (eg, LASIK) if the refractive surgery is not a covered benefit under the member's contract.

S0800
S0810
S0596

Background and Evidence Summary

background: Scanning computerized ophthalmic diagnostic imaging for the anterior segment includes multiple technologies: AS-OCT (anterior segment optical coherence tomography), a rapid non-contact, high-resolution tomographic modality for cornea, iris, anterior chamber and central lens imaging; Pentacam / rotating Scheimpflug camera systems that image cornea and anterior segment with tomography and pachymetry modes; SLO (scanning laser ophthalmoscopy / confocal laser scanning ophthalmoscopy) providing quantitative topographic/confocal measurements; and SLP (scanning laser polarimetry) measuring polarization changes to assess nerve-fiber layer thickness.

evidence summary: These imaging modalities provide detailed quantitative and qualitative anterior segment information and show promise for applications such as angle assessment, biometry, tumor characterization, bleb evaluation, intra-operative guidance, and angiography; however, most studies are preliminary (case series, cross-sectional studies, pilot studies, and systematic reviews) and there are no consistent data demonstrating improved clinical outcomes. For many indications the evidence is insufficient to establish clinical value and several uses are considered experimental and investigational.

Evidence item	Key finding
AS-OCT sensitivity vs gonioscopy (Nolan 2007)
AS-OCT identified 98% of subjects with angle closure on gonioscopy in dark conditions (95% CI: 92.2-99.6); specificity 55.4% (95% CI:45.2-65.2).
CCT correlation (Zhao 2007)
Pearson r = 0.93 between Visante AS-OCT and ultrasound pachymetry; Visante readings consistently less by mean 16.5 ± 11.7 μm (p < 0.001).
Reproducibility (Radhakrishnan 2007)
Anterior chamber depth ICC 0.93 to 1.00; ACA parameters ICC short-term 0.67-0.90; long-term 0.56-0.93; inferior quadrant lower (0.31-0.73).
Piotrowiak 2014
AS-SOCT detected measurable base curve changes with 0.1 mm BCR steepening; lower sensitivity than fluorescein pattern for apical clearance.
Maram 2015
Intra-grader ICCs excellent (AOD500=0.95, AOD750=0.97); inter-grader lower (AOD500=0.71, TISA500=0.49).
Ehlers 2014/2015
Intra-operative OCT feasible (98–99% imaging success); altered surgical decision-making in substantial fraction (19–48% depending on procedure); no adverse events attributed to scanning.
Ang 2015
Anterior segment OCTA protocol reproducible (κ=0.76 image quality; ICC=0.94 vasculature measurements); visualized corneal neovascularization.
Desmond 2022 systematic review
AS-OCT sensitivity range 46–100% (median 87%); specificity 55.3–100% (median 84%); cannot replace gonioscopy.
Marin 2022
Systematic review of AS-OCT image analysis: main applications glaucoma, corneal segmentation, biometry; deep learning rising since 2019.
Matsumiya 2021
AS-OCT showed epithelial hyper-reflective lesions and thickness changes in belantamab-associated superficial keratopathy; findings improved after drug withholding.
Study types
case reports, retrospective case-series, prospective cross-sectional, pilot studies, systematic reviews
Common findings
AS-OCT provides high-resolution, non-invasive imaging useful for morphological assessment; limitations include limited penetration depth (1-3 mm) and poor penetration through pigmented lesions.
Outcomes evidence
No consistent data demonstrating improved clinical outcomes from AS-OCT use; studies often preliminary and small.
Specific metrics reported
Measurements like central corneal thickness, anterior chamber depth, angle opening distance, trabecular iris space area, vessel density, bleb reflectivity, insertion-to-limbus distances, pixel intensity for corneal opacity quantification.
Reference count
Citations 41-78 (literature supporting use of anterior segment OCT and ultrasound biomicroscopy across multiple indications)

Definitions

definitions: AS-OCT — non-contact high-resolution imaging of cornea, iris, anterior chamber and lens.

definitions: Pentacam — rotating Scheimpflug camera system for corneal and anterior segment imaging with multiple evaluation modes including tomography and pachymetry.

definitions: SLO — scanning laser ophthalmoscopy (confocal laser scanning ophthalmoscopy) providing quantitative topographic measurements using confocal laser scanning microscopy.

definitions: SLP — scanning laser polarimetry measuring change in linear polarization to assess nerve fiber layer thickness.

definitions: AS-OCT — An additional entry in the list: noncontact imaging modality for anterior eye structures.

definitions: iOCT — intra-operative optical coherence tomography (microscope-mounted or integrated OCT used during surgery).

definitions: AS-OCTA — anterior segment OCT angiography, adaptation of OCTA to visualize corneal and limbal vasculature.

definitions: AS-OCT — a repeated entry: anterior segment optical coherence tomography; non-contact imaging modality for anterior ocular structures.

definitions: HR-OCT — high-resolution optical coherence tomography (anterior segment variant).

definitions: AS-OCTA — anterior segment optical coherence tomography angiography for imaging conjunctival and intrascleral vasculature.

Revision History

2008-03-21Policy effective

Policy effective date as listed in the document.

2023-10-06Last reviewLatest

Last review date for the policy as listed in the document.

2024-08-08Next review

Next scheduled review date for the policy as listed in the document.

OpenPayer

Anterior Segment Scanning Computerized Ophthalmic Diagnostic Imaging