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Insurance Coverage for Corneal Cross-Linking (2020)

Corneal Crosslinking Insurance Coverage in the United States April 2020

How much does Crosslinking for Keratoconus cost?

There is limited evidence on the costs of corneal crosslinking, but it may be as high as $2,500 to $4,000 per eye in the United States. a cost-effectiveness study estimated the costs of the total treatment for one person as £928 in the UK National Health Service.

Is crosslinkig for keratoconus covered by health insurance?

Since FDA approval of corneal collagen crosslinking (CXL) for keratoconus in April 2016, many insurance companies have started covering this procedure for progressive keratoconus and keratectasia.

What is the CPT code for corneal collagen crosslinking?

Category III CPT 0402T: Collagen crosslinking of cornea, including removal of the corneal epithelium and intraoperative pachymetry when performed.

CPT Category III codes represent temporary codes for new and emerging technologies. They have been created to allow for data collection and utilization tracking for new procedures or services. With this Category III code the individual payers will decide whether to cover the procedure.

Which corneal crosslinking method is covered?

FDA has approved corneal collagen crosslinking (CXL) for progressive keratoconus in April 2016. this approval only covers the crosslinking products developed by Glaukos Corporation (formerly Avedro, Inc.). this FDA-approved method involves corneal epithelial debridment, hence it is known as epithelium-off or epi-off crosslinking.

At this time, epi-on crosslinking method is not approved by FDA and thus it is not covered.

Below is an updated list of insurance companies in United States that cover corneal collagen crosslinking (CXL) for progressive keratoconus:

Payer Name Payer Region
Aetna National
AmeriHealth DE, NJ, PA
Anthem National
Arkansas Blue Cross Blue Shield AR
BCBS Health Advantage AR
Blue Cross Blue Shield FEP National
Blue Cross Blue Shield of Alabama AL
Blue Cross Blue Shield of Arizona AZ
Blue Cross Blue Shield of Florida FL
Blue Cross Blue Shield of Georgia GA
Blue Cross Blue Shield of Illinois IL
Blue Cross Blue Shield of Kansas KS
Blue Cross Blue Shield of Kansas City Kansas City, Northwestern MO, Johnson & Wyandotte Counties
Blue Cross Blue Shield of Louisiana LA
Blue Cross Blue Shield of Massachusetts MA
Blue Cross Blue Shield of Michigan MI
Blue Cross Blue Shield of Minnesota MN
Blue Cross Blue Sheild of Mississippi MS
Blue Cross Blue Shield of Montana MT
Blue Cross Blue Shield of New Mexico NM
Blue Cross Blue Shield of North Carolina NC
Blue Cross Blue Shield of North Dakota ND
Blue Cross Blue Shield of Oklahoma OK
Blue Cross Blue Shield of Rhode Island RI, CT, MA
Blue Cross Blue Shield of South Carolina SC
Blue Cross Blue Shield of Tennessee TN
Blue Cross Blue Shield of Texas TX
Blue Cross and Blue Shield of Vermont VT
Blue Cross of Idaho ID
Blue Shield of California CA
BlueChoice Health Plan of South Carolina SC
Capital Blue Cross Central PA
Capital Health Plan FL
CareFirst Blue Cross Blue Shield MD, DC, Northern VA
Cigna Health National
ConnectiCare CT
Dean Health Plan WI
Emblem Health NY
Empire Blue Cross Blue Shield NY
Fallon Health MA
Geisinger Health PA, DE, ME, NJ, WV
Harvard Pilgrim MA
Hawaii Medical Service Association HI
Health Alliance Plan of Michigan MI
Health New England MA
HealthNet CA, AZ
HealthPartners Minnesota MN, ND, SD, WI
Highmark Blue Shield DE, PA, WV
Horizon Blue Cross of New Jersey NJ
Humana National
Independence Blue Cross PA, NJ, DE, MD
John Hopkins HealthCare MD
Kaiser Permanente AZ, CA, CO, DC, GA, HI, MD, NV, TX, VA, WA
Medica Health Plans MN, WI, ND, SD
Medical Mutual OH
Moda Health OR
Nebraska Blue NE
Premera Blue Cross WA, OR, AK
Presbyterian Health NM, AZ, CO, TX
Priority Health of Michigan MI
Providence Health Plan OR, WA
Public Employee Health Plan (PEHP) UT
Quartz - Unity Health WI
Regence Blue Cross Blue Shield ID, OR, UT, WA
Rocky Mountain Health Plans CO, NE
Scott & White Health Plan (SWHP) TX
Select Health ID, UT
Tricare TRICARE Policy Manual: Rare Diseases, Eye And Ocular Adnexa, Available to all Tricare beneficiaries, including dependents. also see this comment.
Tufts Health Plan MA, RI
United Healthcare National
Wellmark Blue Cross and Blue Shield IA, SD
This list is subject to change. It is not intended to be a directive, nor is it a suggestion about the likelihood of coverage or reimbursement. Please confirm with your individual carriers.

Reimbursement questions and financial assistance

The ARCH (Avedro Reimbursement Customer Hub) program is a service to help keratoconus patients with reimbursement questions, prescription assistance and the possibility of financial assistance for eligible patients.

Call the ARCH Hotline 844-528-3311 for questions about coding, billing, claims submissions or payer coverage for corneal cross-linking with Photrexa® Viscous and Photrexa® with the KXL® System.

Visit Avedro's website to learn more about insurance coverage and find cornea specialist who perform corneal crosslinking.

Learn more about corneal collagen crosslinking (CXL)


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