Currentblue cross blue shield - kansasPolicy N/A

Topography/Photokeratoscopy (Computer-Assisted Corneal Topography)

This policy governs the use and coverage of computer-assisted corneal topography/photokeratoscopy for diagnosing and monitoring corneal disorders for Blue Cross Blue Shield of Kansas members.

Policy Summary

Payerblue cross blue shield - kansas

PolicyTopography/Photokeratoscopy (Computer-Assisted Corneal Topography)

Policy CodePolicy N/A

Change TypeICD-10 codes converted to rangescoding section revised

Effective DateSeptember 13, 2019

Next Review DateN/A

Key ActionVerify member benefits and any prior authorization requirements with BCBSKS before ordering computer-assisted corneal topography.

SourceLink

POLICY UPDATE CHANGES

Converted ICD-10 Codes to ranges and removed specific ICD-10 codes from the policy.

Policy reviewed with no changes made on 08-12-2025.

1Routine use NMN

5+Medically necessary indications

2024-01-18Literature update

RangesICD-10 revisions

92025

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Coverage Criteria for Computer-Assisted Corneal Topography

Computer-Assisted Corneal Topography Coverage

Covered when criteria below are met; routine testing is not covered.

Routine use: Routine computer-assisted corneal topography is considered not medically necessary to detect or monitor diseases of the cornea.

Medically necessary indications: Computer-assisted corneal topography may be considered medically necessary for any of the following: a. Pre- and post-penetrating keratoplasty and pre- and post kerato-refractive surgery for irregular astigmatism; b. Corneal dystrophy and complications of transplanted cornea; c. Diagnosing and monitoring disease progression in keratoconus; d. Post-traumatic or post-infectious corneal scarring; e. Refractive surgery only for symptomatic anisometropia.

List items a-e in policy.

Non-covered indications: Computer-assisted corneal topography is non-covered for the following indications: a. When used in conjunction with preoperative evaluation for cataract surgery including refractive intraocular lens (IOL) exchange and premium channel IOL cataract surgery; b. For difficult fitting of contact lens not associated with refractive surgery; c. Refractive surgery, except when medically necessary for anisometropia.

Items 3.a-3.c in policy.

Denial for unclear indication: Initial and repeat computer-assisted corneal topography that is not clearly medically indicated will be denied as not medically necessary.

Evidence and coverage-relevant conclusions

Evidence summaries and conclusions relevant to coverage decisions:

Clinical validity for keratoconus detection: Retrospective data indicate some vector parameters derived from topography (ocular residual astigmatism and topography disparity) have good diagnostic capability for keratoconus (ocular residual astigmatism cutoff 1.255 D: sensitivity 82%, specificity 92%; topography disparity cutoff 1.035 D: sensitivity 78.5%, specificity 86%), while corneal topographic astigmatism did not perform well.ocular residual astigmatism cutoff 1.255 D; topography disparity cutoff 1.035 D

See Martinez-Abad et al. diagnostic study.

Clinical utility for management decisions: Direct evidence comparing management with and without computer-assisted corneal topography is lacking; because test performance evidence is insufficient, a chain of evidence linking testing to improved health outcomes could not be established.

See Chain of Evidence and Section Summary.

Use in contact lens fitting: Studies report computer-assisted topography can assist design and fitting of gas-permeable and scleral lenses and that stitched wide-field imaging (sMap3D) provides greater coverage than straight-gaze imaging; however, study limitations and small samples limit definitive conclusions about clinical benefit.

Coding-related coverage guidance

Coding and documentation guidance tied to medical necessity:

coding_and_documentation: Use CPT 92025 for computer-assisted corneal topography; non-computer-assisted corneal topography has historically been considered inclusive to evaluation and management services and should not be billed separately.

Code 92025 is listed for computerized corneal topography; verify member contract for coverage.

Coding revisions and risks: The coding section has undergone revisions including conversion/removal of specific ICD-10 codes to ranges; providers should note that these changes may affect claim coding and could trigger denials if diagnosis coding does not match updated policy guidance.

Refer to coding revision history and verify current ICD-10 guidance.

Prior authorization and documentation: Coverage depends on clinical indication per policy; document the clinical indication when submitting claims, as routine computer-assisted topography billed without a listed medically necessary indication may be denied.

Verify member benefits and any prior authorization requirements with BCBSKS Customer Service.

Computer-assisted corneal topography is explicitly designated as non-covered for several elective and non-indicated uses. Specifically, this service is non-covered when performed: (1) in conjunction with preoperative evaluation for cataract surgery including refractive intraocular lens (IOL) exchange and premium-channel IOL cataract surgery; (2) for difficult contact lens fitting that is not associated with refractive surgery; and (3) for refractive surgery except when it is medically necessary for symptomatic anisometropia. These non-covered indications are listed to guide billing and coverage determinations.

The policy concludes that a chain of evidence for clinical utility cannot be established because the available evidence is insufficient to demonstrate test performance and there is a lack of direct evidence linking use of computer-assisted corneal topography to improved health outcomes. Consequently, no inferences about clinical utility can be made from the current literature, and this limitation informs the coverage stance in the policy.

Recent coding revisions converted individual ICD-10 diagnosis entries to ranges and subsequently removed the listing of specific ICD-10 codes from the policy's coding section. This change affects the explicit presentation of diagnosis codes within the policy.

Routine computer-assisted corneal topography is considered not medically necessary. The policy states that initial and repeat testing that is not clearly medically indicated will be denied as not medically necessary. Providers should document a listed medically necessary indication when ordering or billing this service to avoid denial.

The document notes a lack of direct evidence demonstrating that computer-assisted corneal topography changes management in a way that improves health outcomes. While some studies report diagnostic parameters with promising sensitivity and specificity, direct comparative evidence showing clinical usefulness for patient care decisions is lacking, limiting the policy's ability to support broader coverage.

Where the policy does not restate specific not-medically-necessary (NMN) language, refer to the Policy section for NMN determinations. The coding portion of the document focuses on code listings and revision history and does not replace the explicit NMN statements found in the Policy section.

Coding and Diagnosis Codes

Non-Computer-Assisted Corneal Topographymixed

No separate CPT code for non-computer-assisted corneal topography; it is part of evaluation and management services of general ophthalmological services and should not be billed separately.

Included procedure codesCPT/HCPCS

92025

Computerized corneal topography, unilateral or bilateral, with interpretation and report

Covered CPT CodesCPTCovered

92025

Computerized corneal topography

ICD-10 Diagnosis Codes (historical / converted)ICD-10

H16.0xx - H16.4xx (ranges referenced)

Multiple ICD-10 corneal disease codes were added and later converted to ranges or removed from the policy coding section.

Corneal astigmatism threshold for toric IOL candidacy

Toric IOL candidacy threshold> 1 diopter

Source study contextDe Sanctis et al reported candidacy required corneal astigmatism >1 D (77 patients proceeded to IOL implantation)

Measurement methods variabilityDifferent measurement methods (total corneal refractive power vs simulated keratometry) identified different numbers of patients above the >1 D threshold, affecting selection

Provider Actions, Billing, and Documentation

Prior Authorization

Verify benefits / Prior Authorization

Verify member benefits and prior authorization requirements with Blue Cross and Blue Shield of Kansas before scheduling services. Coverage and prior authorization criteria vary by contract and may affect payment.

Check the member's contract and eligibility at time of service.
Contact BCBSKS Customer Service or use the provider portal to confirm prior authorization requirements.

Billing Rule

Coding guidance — computer-assisted corneal topography (92025)

Use CPT code 92025 for computer-assisted corneal topography. Inclusion of this code in the coding list is informational and does not by itself guarantee coverage or reimbursement.

Definitions and Key Terms

Computer-assisted corneal topography (also called photokeratoscopy or videokeratography) is an imaging technique that uses a camera and computerized analysis to produce quantitative, color-coded maps of corneal curvature and shape. It provides a broader surface assessment than traditional keratometry, enabling evaluation of curvature, elevation, depth, and corneal power for diagnosis and monitoring of corneal disorders such as keratoconus, difficult contact lens fits, and pre/postoperative assessment after refractive surgery.

Photokeratoscopy / Computer-assisted corneal topography

DefinitionImaging technique (photokeratoscopy/videokeratography) using a camera and computer analysis to produce quantitative maps of corneal curvature and shape

Primary usesDiagnosis and follow-up of corneal disorders (eg, keratoconus), difficult contact lens fits, and pre/postoperative corneal assessment

Output characteristicsProvides quantitative corneal topographic data and color-coded high-resolution maps of curvature, elevation, depth, and power

Computer-assisted corneal topography — systems and calculations

Revision History and Policy Changes

2010-12-20policy_post

Policy added to the BCBSKS website.

2011-12-09policy_revision

Policy section revised: Item B #5 updated to specify 'Refractive surgery only for symptomatic anisometropia'; Rationale and Reference sections updated.

2013-07-12content_update

Description and Rationale sections updated; ICD-10 diagnosis codes were added to the Coding section (effective October 1, 2014).

Policy Summary

Payerblue cross blue shield - kansas

PolicyTopography/Photokeratoscopy (Computer-Assisted Corneal Topography)

Policy CodePolicy N/A

Change TypeICD-10 codes converted to rangescoding section revised

Effective DateSeptember 13, 2019

Next Review DateN/A

Key ActionVerify member benefits and any prior authorization requirements with BCBSKS before ordering computer-assisted corneal topography.

SourceLink

On This Page

See contact lens fitting studies and imaging coverage comparisons.

Use for toric IOL measurement: Comparative instrument studies found no clear advantage of computerized topography over manual keratometry for corneal astigmatism measurement in at least one study; differences between total corneal refractive power and simulated keratometry methods may influence toric IOL patient selection (corneal astigmatism > 1 D often used as candidacy threshold).corneal astigmatism >1 D for toric IOL candidacy

See comparative studies for toric IOL measurement.

92025 — Computerized corneal topography, unilateral or bilateral, with interpretation and report

Inclusion of a code does not imply the service is covered; the procedure must meet the policy's medical necessity criteria.

Documentation Required

Documentation requirement — clinical indication

Document the clinical indication for initial and repeat computer-assisted corneal topography. Routine or unindicated testing will be denied as not medically necessary.

Document specific clinical reason (e.g., pre/post penetrating keratoplasty, kerato-refractive surgery for irregular astigmatism, corneal dystrophy, keratoconus monitoring, post-traumatic/post-infectious scarring, symptomatic anisometropia).
Initial and repeat tests that are not clearly medically indicated will be denied as not medically necessary.

Note

Provider Actions — None specified

None specified.

Documentation Required

Coding and documentation note

Coding and documentation note: distinguish computer-assisted corneal topography (reportable with CPT 92025) from non-computer-assisted corneal topography, which is considered integral to evaluation and management and should not be billed separately. Removal of specific ICD-10 codes and conversion to ranges or other coding updates may affect claim processing; verify current code sets and submit appropriate diagnosis codes.

Non-computer-assisted corneal topography is part of E/M services and has no separate CPT code.
Ensure claims use CPT 92025 only when the procedure is computer-assisted and an interpretation/report is provided.
Keep coding updated to reflect current ICD-10 guidance; coding changes could impact adjudication and denials.

Example systemsPentacam, sMap3D, Fitscan

What they calculateCorneal curvature and astigmatism, vector differences (eg, total corneal refractive power vs simulated keratometry), and generate topographic maps used for diagnosis and fittings

Clinical applications notedUsed to guide contact lens design/fitting, assess suitability for toric IOLs, and detect/monitor keratoconus

Vector parameters (ocular residual astigmatism, topography disparity)

Ocular residual astigmatismA vector parameter calculated by topography software representing residual astigmatism of the eye; proposed as a diagnostic marker for keratoconus (cutoff 1.255 D)

Topography disparityA derived vector metric quantifying disagreement between topographic measures; proposed as a diagnostic marker for keratoconus (cutoff 1.035 D)

PurposeDerived to improve detection of clinical and subclinical keratoconus when combined with software-based analysis

Computer-assisted corneal topography — CPT 92025 service definition

CPT code92025 — Computerized corneal topography, unilateral or bilateral, with interpretation and report

Service summaryComputer-assisted analysis of corneal surface curvature producing topographic maps with interpretation and report

Coding noteInclusion of CPT 92025 in coding section does not itself guarantee coverage; medical necessity determined by policy clinical indications

2015-07-08content_update

Description, Rationale, and References sections updated.

2016-04-27content_update

Description and Rationale sections updated.

2017-04-12content_update

Description, Rationale, and References sections updated.

2018-04-11coding_update

Removed ICD-9 codes from the Coding section; Description, Rationale, and References sections updated.

2019-04-24content_update

Description, Rationale, and References sections updated in preparation for posting with effective date 2019-09-13.

2019-09-13effective_date

Policy posted to BCBSKS website with an effective date of September 13, 2019.

2021-06-01content_update

Description and Rationale sections updated; Coding section edited.

2022-05-20coding_and_content_revision

Description and Rationale sections updated; Coding section revised to remove coding bullets noting CPT 92025 and that non-computer-assisted topography is inclusive to E/M, and ICD-10 codes were converted to ranges.

2023-04-25coding_revision

Description, Rationale, References updated and ICD-10 codes removed from the policy.

2024-04-23content_update

Description, Rationale, and References sections updated.

2025-08-12policy_reviewLatest

Medical policy reviewed with no changes made.

Material coding changes were made: the policy converted individual ICD-10 diagnosis codes to ranges and removed listed ICD-10 codes from the coding section. These revisions are recorded in the policy's coding revision history and are noted as a material change to the coding presentation.