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Corneal Collagen Cross-Linking Coverage (IB 24-17)

Date: 05/23/24

Louisiana Healthcare Connections is sharing with providers an update to the Corneal Collagen Cross-Linking Coverage (IB24-17).

Effective May 1, 2024, Louisiana Medicaid allows for coverage of corneal collagen cross-linking (CXL) procedures.

CXL is a procedure used to treat progressive keratoconus. Keratoconus is a progressive ocular disease that increases the curvature of the cornea, leading to decreased visual acuity.
Ultraviolet (UV) light is combined with riboflavin eye drops to induce collagen crosslinks in the cornea, strengthening and stabilizing the cornea and delaying progressive deformation. 

The CXL procedure, including the riboflavin drops and administration of UV light, is approved for patients between 14-20 years of age with progressive keratoconus.

Clinical Guidelines
Coverage guidelines for CXL are made in accordance with the Louisiana Medicaid program definition of medical necessity.

The guidelines are as follows:

  • Epithelium-off photochemical CXL using riboflavin and ultraviolet A may be considered medically necessary for treatment of progressive keratoconus when conservative treatments (e.g., spectacles and contact lens) have been tried without success and the individual does not have either of the following contraindications: a corneal thickness of fewer than 400 microns or a prior herpetic ocular infection.
  • Progressive keratoconus is defined as one or more of the following: 
    • An increase of 1 diopter (D) in the steepest keratometry value; or
    • An increase of 1 D in regular astigmatism evaluated by subjective manifest refraction; or
    • A myopic shift (decrease in the spherical equivalent) of 0.50 D on subjective manifest refraction; or
    • A decrease > 0.1 mm in the back optical zone radius in rigid contact lens wearers where other information was not available.

Procedure Codes

CXL can be billed using the following codes:

  • 0402T: collagen cross-linking of cornea (including removal of the corneal epithelium and measurement of corneal thickness).
  • J2787: riboflavin 5’-phosphate, ophthalmic solution, up to 3 mL.

Louisiana Healthcare Connections is updating our systems and will automatically recycle claims. Claims previously submitted will be systematically adjusted to ensure proper payment. No action is required by the provider.

Questions regarding this message and fee-for-service claims are to be directed to Gainwell Technologies at (800) 473-2783 or (225) 924-5040.

Providers with questions for Louisiana Healthcare Connections may contact their Provider Representative at 1-866-595-8133