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HCPCS/CPT C1818, Integrated keratoprosthesis | No Prior Auth

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`C1818`, Integrated keratoprosthesis

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

Note that individuals should be able and expected to comply with postoperative care.

Key Coverage Criteria

Keratoprosthesis using the Dohlman Doane Boston KPro (“Boston KPro”) device is consideredmedically necessaryfor the treatment of corneal blindness wheneitherof the following criteria are met (AorB):
For individuals with prior corneal transplant:The cornea is severely opaque and vascularized;andThere is documentation of at least one prior failed corneal transplant procedure;or
The cornea is severely opaque and vascularized;and
There is documentation of at least one prior failed corneal transplant procedure;or
There is documentation of the presence of a condition predisposing the individual to a high likelihood of corneal transplant failure, including but not limited toanyof the following:Autoimmune conditions with ocular involvement;orHeavily vascularized corneal scars;orLimbal stem cell compromise;orMucus membrane pemphigoid;orNeuropathic keratopathy;orOcular chemical burns;orOcular cicatricial pemphigoid;orPostherpetic anesthesia;orSevere dry eye;orStevens-Johnson Syndrome.
Autoimmune conditions with ocular involvement;or

5 Active Policies

ANTHEM-CG-SURG-94, Keratoprosthesis

BCBSIL-OTH903.030, Keratoprosthesis

BCBSMT-OTH903.030, Keratoprosthesis

BCBSNM-OTH903.030, Keratoprosthesis

BCBSOK-OTH903.030, Keratoprosthesis

Related Codes

65770(5 policies)L8609(5 policies)B02.23(1 policies)H04.121(1 policies)H04.129(1 policies)H16.441(1 policies)H16.449(1 policies)B02.29(1 policies)

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