CurrentBlue Cross Blue Shield - IowaPolicy N/A

Computer-Assisted Corneal Topography

Defines Wellmark/Blue Cross Blue Shield - Iowa medical policy on use of computer-assisted corneal topography (photokeratoscopy) including indications considered medically necessary, investigational uses, summary of evidence, regulatory status, and coding guidance.

Policy Summary

PayerBlue Cross Blue Shield - Iowa

PolicyComputer-Assisted Corneal Topography

Policy CodePolicy N/A

Change TypeRenewal (no material change)

Effective Date1997-11

Next Review Date

Key ActionDocument the specific corneal condition that meets the policy's medically necessary indications in the medical record to support coverage for corneal topography.

POLICY UPDATE CHANGES

Policy revised January 2023 and May 2025 (annual reviews/renewals listed).

8Medically Necessary Indications Listed

1CPT Code Specified

MultipleFDA-cleared Devices Listed

Coverage Summary

This policy defines Wellmark/Blue Cross Blue Shield - Iowa coverage for computer-assisted corneal topography (photokeratoscopy), a quantitative technique for measuring corneal curvature used in diagnosis and follow-up of corneal disorders. Coverage stance is mixed: testing is accepted/medically necessary for selected corneal indications but evidence is considered insufficient to demonstrate improved net health outcome broadly. The policy specifies CPT code 92025 for computerized corneal topography. The policy was last reviewed in May 2025 and was renewed with no material coverage change.

Medical-Necessity Criteria

Medically Necessary Indications

Computer-assisted corneal topography may be considered medically necessary to evaluate the following corneal conditions:

ALL of the following

ONE OF
- Bullous keratopathy
- Corneal dystrophies
- Corneal ectasia
- Keratoconus for an initial diagnosis and monitoring disease progression
- Irregular corneal astigmatism
- Post-traumatic corneal scarring
- Transplanted cornea complications

Investigational / Not Medically Necessary

Computer-assisted corneal topography is considered investigational when the above criteria have not been met.

ALL of the following

Any use not meeting the listed medically necessary indications

Provider Actions

Documentation Required

Clinical Indication Documentation

Document the specific corneal condition (for example, keratoconus, corneal ectasia, irregular corneal astigmatism, bullous keratopathy, corneal dystrophies, post-traumatic corneal scarring, transplanted cornea complications) in the patient's medical record to show the service meets the policy's medically necessary indications and to support coverage for corneal topography.

92025

Prior Authorization

Prior Authorization Not Applicable

Policy indicates prior approval is not applicable; no prior authorization requirement is specified for computer-assisted corneal topography.

Denial Risk

Coverage Denial Risk for Unlisted Indications

Claims for computer-assisted corneal topography that are for indications not listed as medically necessary in this policy may be considered investigational and may be denied.

92025

Background & Evidence

Computer-assisted corneal topography (also called photokeratoscopy, videokeratography) uses image analysis to provide quantitative corneal topographic data including curvature, elevation, and power. It is used to aid diagnosis and follow-up of corneal conditions such as keratoconus, difficult contact lens fits, and pre-/postoperative corneal assessment, and can detect and monitor disease (e.g., keratoconus).

Although the evidence base includes randomized and nonrandomized studies, the policy concludes the evidence is insufficient overall to demonstrate improved net health outcomes. Despite this, corneal topography is considered medically necessary for selected indications when policy criteria are met (examples: bullous keratopathy, corneal dystrophies, corneal ectasia, keratoconus for diagnosis and monitoring, irregular corneal astigmatism, post-traumatic corneal scarring, and transplanted cornea complications). Uses not meeting the listed indications are considered investigational/not medically necessary.

Evidence summary

Definitions & Guidelines

Revision History

2023-01revised

Policy revised January 2023 (annual review) per policy history; listed as a revision in the policy history and revised date.

2025-05revisedLatest

Policy revised/renewed May 2025 (annual review) resulting in policy renewal with no documented material coverage changes.