CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Corneal Topography / Computer-Assisted Corneal Topography (Photokeratoscopy / Videokeratography)

Policy addresses coverage and medical necessity of computer-assisted corneal topography (CPT 92025) for BlueCHiP for Medicare and Commercial products; distinguishes computer-assisted testing from non-computer-assisted topography and clarifies billing inclusion in ophthalmologic E/M when non-computer methods are used.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyCorneal Topography / Computer-Assisted Corneal Topography (Photokeratoscopy / Videokeratography)

Policy CodePolicy N/A

Change TypeNo material change

Effective DateOct 1, 2015

Next Review Date

Key ActionDo not submit CPT code 92025 for computer-assisted corneal topography for BlueCHiP for Medicare or Commercial products; document non-computer-assisted topography as part of ophthalmologic E/M services.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

92025CPT code explicitly listed as not covered / not medically necessary

BlueCHiP & CommercialLines of business for which computer-assisted corneal topography is not medically necessary

InclusiveConsidered inclusive to E/M services (CPT 92002-92014)

Coverage Determinations

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Coverage determination

Covered when ALL of the following are met:

Computer-assisted corneal topography is considered not covered / not medically necessary to detect or monitor diseases of the cornea for BlueCHiP for Medicare because the evidence is insufficient to determine the effects of the technology on health outcomes.
Computer-assisted corneal topography is considered not medically necessary to detect or monitor diseases of the cornea for Commercial products because the evidence is insufficient to determine the effects of the technology on health outcomes.

Non-computer-assisted corneal topography billing

Billing guidance for non-computer-assisted corneal topography:

Non-computer-assisted corneal topography is considered part of the evaluation and management services of ophthalmologic services (CPT codes 92002-92014) and should not be billed separately.
There is no separate CPT code for non-computer-assisted corneal topography; it is inclusive to evaluation and management services.

Billing Guidance & Documentation

Documentation Required

Do not bill 92025 when service is not covered

Do not submit CPT code 92025 for computer-assisted corneal topography for BlueCHiP for Medicare or Commercial products because the service is considered not covered / not medically necessary; when non-computer-assisted corneal topography is performed, document it as part of the ophthalmologic evaluation and management (CPT 92002-92014) rather than billing a separate code.

Affected codes: 92025
Inclusive to E/M: 92002-92014

Clinical and Technical Context

Corneal topography measures the curvature of the cornea and is used clinically to aid in the diagnosis and follow-up of corneal disorders such as keratoconus, to assist with difficult contact lens fitting, and for pre- and postoperative assessment of the cornea, most commonly after refractive surgery.

There are multiple techniques to assess corneal shape and curvature. Traditional, non-computer-assisted methods include the keratometer (ophthalmometer) and the keratoscope/photokeratoscope, which provide qualitative or limited central curvature measurements. Computer-assisted photokeratoscopy (also called videokeratography or computer-assisted corneal topography) uses image analysis programs to create quantitative, high-resolution, color-coded maps of corneal curvature and can measure curvature, elevation, and power.

While computer-assisted mapping provides detailed quantitative data and has been used for early identification and documentation of progression in conditions such as keratoconus, the evidence from clinical trials is insufficient to demonstrate that computer-assisted corneal topography improves health outcomes. Therefore, computer-assisted corneal topography is considered not medically necessary / not covered for the lines of business addressed in this policy.

Defined Terms

Definitions

Computer-assisted corneal topographyAlso called photokeratoscopy or videokeratography; uses image analysis programs to provide quantitative corneal topographic data including curvature, elevation, and power.

Non-computer-assisted corneal topographyMethods such as keratometry or keratoscopy without computerized analysis; considered part of standard ophthalmologic evaluation and inclusive to evaluation and management (CPT 92002-92014).

Policy Details

Policy Dates, Scope, and Status

Effective Date2015-10-01

Last Review2018-08-21

Next Review

Policy NumberN/A

Scope SummaryPolicy addresses coverage and medical necessity of computer-assisted corneal topography (CPT 92025) for BlueCHiP for Medicare and Commercial products; distinguishes computer-assisted testing from non-computer-assisted topography and clarifies billing inclusion in ophthalmologic E/M when non-computer methods are used.

Coverage StanceComputer-assisted corneal topography (CPT 92025) is considered not covered / not medically necessary for BlueCHiP for Medicare and Commercial products (evidence is insufficient to determine effects on health outcomes).

StatusCURRENT