Anterior Segment Scanning Computerized Ophthalmic Diagnostic Imaging
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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.
No material clinical or coverage changes — this policy has no listed changes in the brief and has has_material_change=false.
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.
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
- Diagnosis/management of pigmentary dispersion syndrome
- Evaluation of anterior segment morphology of hyperopia
- Evaluation of belantamab-associated superficial keratopathy
- Evaluation of benign reactive lymphoid hyperplasia
- Evaluation of blebs after filtering surgery
- Evaluation of conjunctival amyloidosis
- Evaluation of conjunctival hyperemia
- Evaluation of conjunctival lymphoma
- Evaluation of corneal and conjunctival tumors
- Evaluation of ocular surface squamous neoplasia
- Evaluation of post-operative opacification of intra-ocular lens
- Evaluation of strabismus
- Evaluation of the proximal lacrimal system
- Identification of fungal infections with endophthalmitis after cataract surgery
- Imaging of extra-ocular rectus muscle insertions for pre-operative planning
- Management of Wilson disease
- Prediction of post-operative outcomes following trabeculectomy
- Quantification of corneal haziness
Anterior segment imaging using Pentacam / SLO / SLP
- Pentacam (anterior segment imaging of ciliary body, cornea, iris and lens) — insufficient evidence of effectiveness
- Scanning laser ophthalmoscopy (SLO) / confocal laser scanning ophthalmoscopy — insufficient evidence of effectiveness
- Scanning laser polarimetry (SLP) / confocal scanning laser polarimetry — insufficient evidence of effectiveness
Policy Limitations and Exclusions
Notes on contractual exclusions and noncoverage tied to excluded procedures:
ALL of the following
- Pentacam anterior segment imaging for any indication relating to refractive eye surgeries (eg, LASIK, laser eye surgery, etc.) is not covered when the refractive surgery itself is not a covered benefit; refractive eye surgeries are generally excluded by contract.
Coding
| 92132 | Scanning computerized ophthalmic diagnostic imaging, anterior segment, with interpretation and report, unilateral or bilateral. |
| 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. |
| 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]. |
Provider Actions & Billing Guidance
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.
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
Policy effective date as listed in the document.
Last review date for the policy as listed in the document.
Next scheduled review date for the policy as listed in the document.
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