Insurance Coverage for Corneal Cross-Linking in the U.S. (2024)

FAQs

Insurance Coverage for Corneal Cross-Linking in the U.S.? ›

There are two types of corneal cross-linking: epithelium-off cross-linking and epithelium-on cross-linking, but only epithelium-off cross-linking is presently FDA approved. This means that insurance companies will usually cover epithelium-off cross-linking, but they almost never cover epithelium-on cross-linking.

Upwards of 95% of medical insurances cover corneal cross-linking. Medical insurance is also valuable if your keratoconus is advanced to the level of needing corneal transplantation. By comparison, a vision plan can help you get the specialty contact lens prescribing needed for optimal vision.

Corneal Cross Linking Cost

The average cost of a corneal cross-linking procedure typically ranges from $2,500 to $4,000 per eye.

VSP and EyeMed do not cover corneal crosslinking but Care Credit, HSA and FSA can be used for these procedures. INTACS: Corneal INTACS implants are sometimes covered by health insurance provided the proper documentation that the procedure is medically necessary.

The best way to do this is to submit a predetermination for both 0402T Collagen cross-linking (including removal of the corneal epithelium and intraoperative pachymetry when performed) and J3490 Unclassified drug.

Insurance does not typically cover products and procedures that have not received FDA approval. The only FDA-approved products for cross-linking are from Avedro, and are performed epi-off.

If I do not have insurance, what does corneal crosslinking cost? If your insurance plan does not cover corneal crosslinking (or you are without insurance), corneal cross-linking can cost between $2,500 to $4,000 per eye.

However – according to the American Academy of Ophthalmology (AAO) – corneal cross-linking is only covered if an FDA-approved method (with concomitant approved medication) is utilized. Both Medicare Parts A and B only cover 80 percent of healthcare costs.

The corneal cross-linking success rate is 95%. For the 5% of patients who don't respond to treatment, this is usually due to underlying health conditions disrupting the recovery process.

Even so, some studies suggest that people really do see better after cross-linking. In a 2014 study, researchers found that about half of people who had cross-linking had an improvement of one line in visual acuity two years after surgery.

Does Aetna cover corneal cross-linking? ›

While cross-linking is not covered by all commercial plans, there has been a significant increase in the number of plans that do cover it, including most of the Blue Shield plans, Aetna (i), and Kaiser Permanente (ii). A full list of payers with positive coverage policies is available at www.livingwithkeratoconus.com.

Thankfully, most costs associated with keratoconus usually are covered by health or medical insurance. In particular, medical insurance typically covers most of the cost of corneal cross-linking or major keratoconus surgery (less deductibles and copays determined by your policy).

Many research studies have shown that CXL may prevent further vision loss in over 95% of patients and improves vision in 60-81% of patients treated.

Other requirements to be a good candidate for corneal cross-linking include: Eyes that are otherwise healthy and free from disease. Good general health, with no autoimmune disorders. No corneal scarring.

Yes. Corneal crosslinking is a highly effective FDA-approved treatment to stop the progression of keratoconus. If there is continued progression of the disease despite the first procedure, it can be repeated. Unfortunately, there are cases where the disease progresses despite repeat crosslinking.

In simple terms, the younger the patient is at the first cross-linking, the higher the likelihood that they will need a second treatment after 7−8 years. The cornea is completely rebuilt every 7−8 years – a fact that has only recently come to light.

Health insurance usually doesn't cover the cost of refractive or laser eye surgery, but some companies will pay the bill if certain criteria are met. Some insurance companies offer a vision plan which may provide a discounted price or apparent partial coverage for laser eye surgery.

For members with progressive keratoconus corneal collagen cross-linking is considered medically necessary when all of the following conditions are met: a. Diagnosis of keratoconus based on keratometry and corneal mapping; and b. Any of the following changes have occurred within 24 months: i.

The Food and Drug Administration (FDA) approved Avedro Inc.'s corneal cross-linking system (KXL) for treatment of patients with progressive keratoconus and post-laser in situ keratomileusis ectasia in April 2016.