Computerized Corneal Topography

LCD Information Document Information Source LCD ID N/A LCD ID L34008 Original ICD-9 LCD ID Not Applicable LCD Title Computerized Corneal Topography Proposed LCD in Comment Period N/A Source Proposed LCD N/A Original Effective Date For services performed on or after 10/01/2015 Revision Effective Date For services performed on or after 01/22/2026 Revision Ending Date N/A Retirement Date N/A Notice Period Start Date N/A Notice Period End Date N/A CPT codes, descriptions, and other data only are copyright 2025 American Medical Association. All Rights Reserved. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. CPT is a registered trademark of the American Medical Association. 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Issue Issue Description This LCD outlines limited coverage for this service with specific details under Coverage Indications, Limitations and/or Medical Necessity. Issue - Explanation of Change Between Proposed LCD and Final LCD CMS National Coverage Policy Language quoted from Centers for Medicare and Medicaid Services (CMS), National Coverage Determinations (NCDs) and coverage provisions in interpretive manuals is italicized throughout the policy. NCDs and coverage provisions in interpretive manuals are not subject to the Local Coverage Determination (LCD) Review Process (42 CFR 405.860[b] and 42 CFR 426 [Subpart D]). In addition, an administrative law judge may not review an NCD. See Section 1869(f)(1)(A)(i) of the Social Security Act.Unless otherwise specified, italicized text represents quotation from one or more of the following CMS sources:Title XVIII of the Social Security Act (SSA):Section 1862(a)(1)(A) excludes expenses incurred for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.Section 1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim. Section 1862 (a)(10) excludes cosmetic surgery.Code of Federal Regulations:42 CFR Section 410.32, indicates that diagnostic tests may only be ordered by the treating physician (or other treating practitioner acting within the scope of his or her license and Medicare requirements) who furnishes a consultation or treats a beneficiary for a specific medical problem and who uses the results in the management of the beneficiary's specific medical problem. Tests not ordered by the physician (or other qualified non-physician provider) who is treating the beneficiary are not reasonable and necessary (see Sec. 411.15(k)(1) of this chapterCMS Publications:CMS Publication 100-02, Medicare Benefit Policy Manual, Chapter 15: 80 Requirements for Diagnostic X-Ray, Diagnostic Laboratory, and Other Diagnostic Tests Coverage Indications, Limitations, and/or Medical Necessity Abstract:Corneal topography is a computer assisted diagnostic technique where a special instrument projects a series of light rings on the cornea, creating a color coded map of the corneal surface as well as a cross-section profile. This service is used to provide a detailed map or chart of the physical features and shape of the anterior surface of the cornea. This permits a more nearly accurate portrayal of the physical state of the cornea and for the detection of subtle corneal surface irregularity and astigmatism. Indications:Computerized corneal topography is considered medically necessary under any of the following conditions: pre-operative evaluation of irregular astigmatism for intraocular lens power determination with cataract surgery; monocular diplopia; diagnosis of early keratoconus; post-surgical or post-traumatic astigmatism, measuring at a minimum of 3.5 diopters; suspected irregular astigmatism based on retinoscopic streak or conventional keratometry; post-penetrating keratoplasty surgery; post-surgical or post-traumatic irregular astigmatism; certain corneal dystrophies; complications of transplanted cornea; post-traumatic corneal scarring; and/or pterygium and/or corneal ectasia that cause visual impairment. Limitations:Corneal topography will only be allowed for a pre-operative cataract patient if documentation supports that the patient has irregular astigmatism. Its use for this purpose should be rare.Corneal topography is to be billed only when the diagnosis of monocular diplopia is thought to be caused by a corneal irregularity.Corneal topography is a covered service for the above indications when medically reasonable and necessary only if the results will assist in defining further treatment. It is not covered for routine follow-up testing.Repeat testing is only indicated if a change of vision is reported in connection with one of the above listed conditions.Services performed for screening purposes or in the absence of associated signs, symptoms, illness or injury as indicated above, will be denied as non-covered.Corneal topography will be non-covered if performed pre- or post-operatively in relation to a Medicare non-covered procedure, e.g., radial keratotomy. Other Comments:For claims submitted to the Part A MAC: this coverage determination also applies within states outside the primary geographic jurisdiction with facilities that have nominated CGS Administrators, LLC. to process their claims.Limitation of liability and refund requirements apply when denials are likely, whether based on medical necessity or other coverage reasons. The provider/supplier must notify the beneficiary in writing, prior to rendering the service, if the provider/supplier is aware that the test, item or procedure may not be covered by Medicare. The limitation of liability and refund requirements do not apply when the test, item or procedure is statutorily excluded, has no Medicare benefit category or is rendered for screening purposes. Summary of Evidence N/A Analysis of Evidence (Rationale for Determination) N/A

Abstract: Corneal topography is a computer assisted diagnostic technique where a special instrument projects a series of light rings on the cornea, creating a color coded map of the corneal surface as well as a cross-section profile. This service is used to provide a detailed map or chart of the physical features and shape of the anterior surface of the cornea. This permits a more nearly accurate portrayal of the physical state of the cornea and for the detection of subtle corneal surface irregularity and astigmatism. Indications: Computerized corneal topography is considered medically necessary under any of the following conditions: pre-operative evaluation of irregular astigmatism for intraocular lens power determination with cataract surgery; monocular diplopia; diagnosis of early keratoconus; post-surgical or post-traumatic astigmatism, measuring at a minimum of 3.5 diopters; suspected irregular astigmatism based on retinoscopic streak or conventional keratometry; post-penetrating keratoplasty surgery; post-surgical or post-traumatic irregular astigmatism; certain corneal dystrophies; complications of transplanted cornea; post-traumatic corneal scarring; and/or pterygium and/or corneal ectasia that cause visual impairment. Limitations: Corneal topography will only be allowed for a pre-operative cataract patient if documentation supports that the patient has irregular astigmatism. Its use for this purpose should be rare. Corneal topography is to be billed only when the diagnosis of monocular diplopia is thought to be caused by a corneal irregularity. Corneal topography is a covered service for the above indications when medically reasonable and necessary only if the results will assist in defining further treatment. It is not covered for routine follow-up testing. Repeat testing is only indicated if a change of vision is reported in connection with one of the above listed conditions. Services performed for screening purposes or in the absence of associated signs, symptoms, illness or injury as indicated above, will be denied as non-covered. Corneal topography will be non-covered if performed pre- or post-operatively in relation to a Medicare non-covered procedure, e.g., radial keratotomy. Other Comments: For claims submitted to the Part A MAC: this coverage determination also applies within states outside the primary geographic jurisdiction with facilities that have nominated CGS Administrators, LLC. to process their claims. Limitation of liability and refund requirements apply when denials are likely, whether based on medical necessity or other coverage reasons. The provider/supplier must notify the beneficiary in writing, prior to rendering the service, if the provider/supplier is aware that the test, item or procedure may not be covered by Medicare. The limitation of liability and refund requirements do not apply when the test, item or procedure is statutorily excluded, has no Medicare benefit category or is rendered for screening purposes.