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Insurance Carriers Providing Corneal Cross-Linking Coverage

*All names, logos, and brands are property of their respective owners. All company names used are for identification purposes only. Use of these names, logos, and brands does not imply endorsement.

Which insurance companies cover corneal cross-linking for the treatment of progressive keratoconus?

The list of companies that are known to have policies that cover cross-linking is shown below. You can sign up to receive notifications when new insurance carriers cover the procedure. If you would like to know more about the insurance appeals process, you can check out A Patient’s Guide to Navigating the Insurance Appeals Process.

wdt_ID Payer Name Payer Region Policy
1 Aetna National
2 Kaiser Permanente AZ, CA, CO, DC, GA, HI, MD, NV, TX, VA, WA
3 Blue Cross Blue Shield FEP National
4 Blue Shield of California CA
5 Horizon Blue Cross of New Jersey NJ
6 Blue Cross Blue Shield of Tennessee TN
7 CareFirst Blue Cross Blue Shield MD, DC, Northern VA
8 Blue Cross Blue Shield of Massachusetts MA
9 Blue Cross Blue Shield of Alabama AL
10 Regence Blue Cross Blue Shield ID, OR, UT, WA
Payer Name Payer Region Policy

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. Not all information may be the most current or up-to-date. Please confirm with your individual carriers. Reimbursement information provided herein is gathered from 3rd party sources and is presented for illustrative purposes only. This information does not constitute legal or reimbursement advice. Avedro makes no representation or warranty regarding this information or its completeness, accuracy, timeliness or applicability with any particular patient. Avedro specifically disclaims liability or responsibility for the results or consequences of any actions taken in reliance on information in this document. Avedro encourages providers to submit accurate and appropriate claims for services. Laws, regulations and payer policies concerning reimbursement are complex and change frequently. Providers are responsible for making appropriate decisions related to coding and reimbursement submissions. Accordingly, Avedro recommends that customers consult with their payers, reimbursement specialists and/or legal counsel regarding coding, coverage and reimbursement matters.

Does insurance cover FDA-approved cross-linking?

In a growing number of cases, the answer is yes. More and more insurance plans are now covering FDA-approved cross-linking. The latest list of insurers that have policies that cover cross-linking is shown below. The trend has been encouraging, and 66 insurance carriers now cover cross-linking, up from 3 at the beginning of 2017.

Commercial Insurance Coverage for FDA-Approved Cross-Linking in the U.S.

*data on file

Does insurance cover non-FDA approved products?

Generally, insurance does not typically cover products and procedures that have not received FDA approval. As an example, the Blue Cross and Blue Shield Association’s Technology Evaluation Center (Premera BCBS Technology Review) lists as part of their new technology evaluation criteria:

“1. The technology must have final approval from the appropriate governmental regulatory bodies.”

Does insurance cover epi-on procedures?

The only FDA-approved products for cross-linking are from Avedro, and performed epi-off. Many insurance policies have detail about the fact that the epi-off procedure is the only FDA approved treatment for progressive keratoconus that is being covered, while epi-on is not. See the examples below from Aetna, Cigna, and other insurance coverage policies.

Aetna

“Aetna considers epithelium-off photochemical collagen cross-linkage using riboflavin and ultraviolet A medically necessary for keratoconus and keratectasia.

Aetna considers epithelium-on (transepithelial) collagen cross-linkage experimental and investigational for keratoconus, keratectasia, and all other indications.”

Cigna

“Conventional, epithelium-off, corneal collagen crosslinking (C-CXL) using a FDA approved drug/device system (e.g., Photrexa® Viscous or Photrexa® with the KXL® System) (CPT Code® 0402T; HCPCS Code J3490) is considered medically necessary for the treatment of progressive keratoconus and corneal ectasia following refractive surgery.”

BCBS of MA

“Currently, the only CXL treatment approved by the Food and Drug Administration (FDA) is the epithelium-off method. There are no FDA-approved CXL treatments using the epithelium-on method.”

Moda Health

“Moda Health considers corneal collagen cross-linking (CXL) medically necessary if the requested procedure is for epithelium-off photochemical collagen cross-linkage using riboflavin (HCPC: J3490- Avedro’s Photrexa) and ultraviolet A.”

SelectHealth

“SelectHealth covers epithelium-off corneal cross-linking once per lifetime if the following criteria are met: The medicine used is Photrexa Viscous/Photrexa with the KXL device.”

Blue Cross Blue Shield Network Coverage

RESOURCE: How to Navigate the Insurance Appeals ProcessDownload PDF

Frequently Asked Questions

How do I know if I’m getting FDA approved cross-linking?

You can find doctors near you who are performing the FDA-approved procedure by using the Find-A-Physician locator tool.

I am interested in getting epi-on cross-linking or C3R. Does your program help get coverage for this?

Epithelium-off cross-linking with Avedro’s Photrexa® Viscous (riboflavin 5’-phosphate sodium in 20% dextran ophthalmic solution) and Photrexa® (riboflavin 5’-phosphate sodium ophthalmic solution) in conjunction with the KXL System is the only cross-linking procedure that has been approved by the FDA. Our program provides insurance support for the FDA-approved procedure using Avedro’s drug and device.

How will I know if my insurance covers corneal cross-linking?

Contact your insurance provider prior to treatment to see if they currently provide coverage for corneal cross-linking. Aetna, Kaiser, Regence BCBS and BCBS Federal Employee Plan are among many commercial plans that are covering corneal cross-linking.

Avedro works directly with the doctor’s office and insurance company to help facilitate the insurance reimbursement process. Prior to getting the procedure, confirm with your doctor that they are performing Avedro’s FDA approved cross-linking procedure. You can find a list of physicians who are familiar with the cross-linking procedure using our locator tool.

Cross-Linking

Learn more about this outpatient procedure

View our Living with Keratoconus Patient Brochure.

Patient FAQs

Discover answers to the most common questions surrounding cross-linking

Visit the Patient FAQ Section to learn more.

Top Questions to Ask Your Eye Doctor Download PDF

It is estimated that...

1 Out of Every 2,000

persons in the general population have Keratoconus1

You can find more information from the National Keratoconus Foundation.

1. Kennedy R. H., Bourne W. M., Dyer J. A. A 48-year clinical and epidemiologic study of keratoconus. The American Journal of Ophthalmology. 1986;101(3):267–273. doi: 10.1016/0002-9394(86)90817-2.

Corneal cross-linking provides patients a much-needed option to treat this debilitating disease. Patients suffering from progressive keratoconus can now receive a therapeutic treatment that has been rigorously tested and approved."

Mary Prudden, Executive Director for the National Keratoconus Foundation

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Ophthalmologists, optometrists, and opticians are all integral to your overall #KCJourney, but each plays a distinct role when it comes to treating your #keratoconus. Read our latest blog to learn more. https://t.co/ICnlWjKU3S

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