Corneal Topography, Computer Assisted Photokeratography, Video-keratography Printer-Friendly Version   

Medical Policy: 09.03.01 
Original Effective Date: November 1997 
Reviewed: May 2008 
Revised: May 2008 

This policy applies to all products unless specific contract limitations, exclusions or exceptions apply. Please refer to the member's coverage manual for benefit availability. Managed care guidelines related to referral authorization, and precertification of inpatient hospitalization, home health, home infusion and hospice services apply.

Description: 

Corneal topography describes measurements of the curvature of the cornea. An evaluation of corneal topography is necessary for the accurate diagnosis and follow-up of certain corneal disorders, such as keratoconus, difficult contact lens fits, and pre- and postoperative assessment of the cornea, most commonly after refractive surgery. Various techniques and instruments are available to measure corneal topography:

• The keratometer (also referred to as an ophthalmometer), the most commonly used instrument, projects an illuminated image onto a central area in the cornea. By measuring the distance between a pair of reflected points in both of the cornea’s 2 principal meridians, the keratometer can estimate the radius of curvature of 2 meridians. The fact that the keratometer can only estimate the corneal curvature over a small percentage of its surface, and that estimates are based on the frequently incorrect assumption that the cornea is spherical, are limitations of this technique.
• The keratoscope is an instrument that reflects a series of concentric circular rings off the anterior corneal surface. Visual inspection of the shape and spacing of the concentric rings provides a qualitative assessment of topography. A photokeratoscope is a keratoscope equipped with a camera that can provide a permanent record of the corneal topography.
• Computerized or Computer-assisted photokeratoscopy (also known as Computer Assisted Video Keratography [CAVK] and corneal mapping) is an alternative to keratometry or keratoscopy in measuring corneal curvature. This technique uses sophisticated image analysis programs to provide quantitative corneal topographic data. Early computer-based programs were combined with keratoscopy to create graphic displays and high-resolution color-coded maps of the corneal surface. Newer technologies measure both curvature and shape, enabling quantitative assessment of corneal depth, elevation, and power.

A number of devices have received clearance for marketing through the U.S. Food and Drug Administration (FDA) 510(k) mechanism. The Orbscan (manufactured by Orbtek and distributed by Bausch and Lomb) received FDA clearance in 1999. The second generation Orbscan II is a hybrid system that uses both projective (slit scanning) and reflective (Placido) methods. The Pentacam (Oculus) is one of a number of rotating Scheimpflug imaging systems produced in Germany.

Policy: 

An evaluation of corneal topography may be considered medically necessary for the following conditions:

• Corneal dystrophy,bullous keratopathy and complications of transplanted cornea
• Post-traumatic corneal scarring
• Keratoconus

Corneal topography is considered not medically necessary for all other diagnoses.

Note: Non-computerized or computer assisted topography is considered integral to the evaluation and management services.

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Procedure Codes and Billing Guidelines: 

• To report provider services, use appropriate CPT* codes, Alpha Numeric (HCPCS level 2) codes, Revenue codes, and/or ICD-9 diagnostic codes.
• Use CPT code 92025; Computerized corneal topography, unilateral or bilateral, with interpretation and report

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Selected References: 

• American Academy of Ophthalmology. Ophthalmic procedure preliminary assessment; Corneal Topography. Ophthalmology1999;106:1628-1638.
• Rao SK, Padmanabhan P. Understanding Corneal Topography. Ophthalmology 2000;11:248-259.
• Klyce SD. Corneal topography and the new wave. Cornea 2000;19(5):723-73-29.
• Center for Medicare and medicaid Services (CMS) Wisconsin Physicians Service Insurance Corporation. LCD for Corneal Topography (L29971) Last reviewed on 11/01/2007.
• (No authors listed) Corneal topography. American Academy of Ophthalmology. Ophthalmology. 1999 Aug;106(8):1628-38.

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Wellmark Blue Cross and Blue Shield
Medical Policy Analyst
Station 304
636 Grand Ave
Des Moines, Iowa 50309

*Current Procedural Terminology © 2008 American Medical Association. All Rights Reserved.

Wellmark medical policies address the complex issue of technology assessment of new and emerging treatments, devices, drugs, etc.   They are developed to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. Wellmark medical policies contain only a partial, general description of plan or program benefits and do not constitute a contract. Wellmark does not provide health care services and, therefore, cannot guarantee any results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Wellmark or its affiliates. Treating providers are solely responsible for medical advice and treatment of members. Our medical policies may be updated and therefore are subject to change without notice.