Phototherapeutic Keratectomy (PTK)
Defines medical necessity and noncoverage criteria for phototherapeutic keratectomy (PTK) for Medicare Advantage and Commercial products, specifies covered CPT code(s) and covered diagnoses, and notes exclusions and alternatives.
No material changes — policy updated to clarify coverage distinctions but no material change to clinical/coverage determinations.
Coverage Summary
Scope: Defines medical necessity and noncoverage criteria for phototherapeutic keratectomy (PTK) for Medicare Advantage and Commercial products, specifies covered CPT code(s) and covered diagnoses, and notes exclusions and alternatives. Coverage stance: mixed — the policy permits PTK as a covered alternative to lamellar keratoplasty for deeper corneal disease (visual impairment or irritative symptoms from corneal scars, opacities, or dystrophies extending beyond the epithelial layer) but explicitly excludes use as an alternative to superficial mechanical keratectomy for superficial disorders and lists additional noncovered/not medically necessary applications.
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