Medical Coverage Policy Phototherapeutic Keratectomy (PTK)
Defines medical necessity and exclusions for phototherapeutic keratectomy (PTK) for Blue Cross Blue Shield - Rhode Island BlueCHiP for Medicare and commercial products, including indications when PTK is considered medically necessary and when it is not covered or not medically necessary.
No material clinical or coverage changes.
Coverage Summary
Defines medical necessity and exclusions for Phototherapeutic Keratectomy (PTK) for Blue Cross Blue Shield - Rhode Island BlueCHiP for Medicare and commercial products. Payer: BlueCHiP for Medicare and Commercial Products. Effective date: 2018-10-01. Coverage stance: mixed — PTK is considered medically necessary when used as an alternative to lamellar keratoplasty for visual impairment or irritative symptoms from corneal scars, opacities, or dystrophies extending beyond the epithelial layer, while a number of indications (including use as an alternative to superficial mechanical keratectomy for certain superficial dystrophies and other applications such as recurrent corneal erosions or infectious keratitis) are listed as not covered or not medically necessary.