Does Medicare Cover Corneal Cross-Linking?

In this article, we take a look at corneal cross-linking. A procedure used to treat a condition known as Keratoconus.

First, we’ll answer the common question for older Americans, “does Medicare cover corneal cross-linking?” Then we’ll look at what the treatment costs and other helpful info.

Does Medicare Cover Corneal Cross-Linking?

The short answer to this question is maybe. As is usually the case with Medicare, whether Medicare pays or not depends on a few different factors. So let’s dig into what those are to give you a better idea of whether you can expect Medicare to cover this procedure.

In order for Medicare to cover corneal cross-linking, you doctor must consider the procedure to be medically necessary. And a few other conditions have to be met.

First, you have to try more conservative treatment methods such as spectacle correction or rigid contact lessons. If those treatments fail, then Medicare will likely cover corneal cross-linking if you show one or more of the following:

A myopic shift of 0.50 K on subjective manifest refraction
An evaluation by subjective manifest refraction that shows an increase of 1 D in regular astigmatism
An increase of 1 D in the steepest keratometry value
For those who wear rigid contact lens, a decrease of at least 0.1mm in the back optical zone radius

If you meet the above criteria, then Medicare will likely cover the cost of corneal cross-linking.

In the case of corneal collagen cross-linking using riboflavin and ultraviolet A, Medicare will likely not cover the costs. This treatment is not considered medically necessary. It’s because there is not enough evidence to show this treatment produces a meaningful improvement in outcomes.

As is often the case, Medicare Advantage plans differ in what they will and will not cover. Be sure to check with your plan provider and health care provider to get the best idea of whether you will be covered for corneal cross-linking.

How Much Does Corneal Cross-Linking Costs?

Corneal cross-linking does not come cheap as it costs from $2500-$4000 per eye.

About Keratoconus

Keratoconus is a health condition that causes the cornea to become out of shape. The deformation of the eye varies depending on how severe the Keratoconus is. It happens due to a breakdown of collagen fibers in the eye(s).

A normal cornea is shaped like a dome. But a person with a Keratoconus has an eye that is shaped like a cone. If you do not treat this condition, it can last a lifetime.

The condition affects the lens of the eyes, thus affecting the eye’s ability to withstand light.

About Corneal Cross-Linking

One of the ways to treat Keratoconus is corneal cross-linking. Corneal cross-linking can improve and stabilize the cornea as it creates new links between collagen fibers that are in the cornea.

It strengthens the cornea’s tissues by using an eye drop medication and ultraviolet (UV) light.

The eye drop medication contains specialty formulated riboflavin – known by many as Vitamin B. Your doctor will apply the eye drop with Vitamin B for about 30 minutes. Next s/he will expose your eyes to UV lights for nearly 30 minutes. Finally they will place a bandage contact lens over the eye which will stay there for about a week.

The UV light rays activate the Vitamin B in the cornea. After the procedure, the bandage lens covers the eye(s) and helps the cornea in its recovery.

This procedure can be performed with other procedures that can treat Keratoconus. One of the procedures that can be performed with corneal cross-linking is the implantation of Intacs. Intacs are tiny arc-shaped corneal inserts that reshape and stabilize the cornea.

As of now, this is the only procedure that can stop progressive Keratoconus. People who undergo this procedure do not have to worry too much as this is a minimally invasive procedure.

Two Types of Cross-Linking Procedures

There are two ways to perform this procedure – Epithelium-off cross-linking and Epithelium-on cross-linking.

In Epithelium-off cross-linking, a doctor will remove the epithelium to allow the eye drop to penetrate the deeper corneal tissue more easily. The epithelium is the thin outer layer of the cornea.

On the other hand, Epithelium-on cross-linking no longer requires removing the epithelium, making it a less invasive procedure. But despite being a less painful and invasive procedure, the epithelium-on cross-linking is not FDA-approved, unlike the epithelium-off procedure.

Insurance companies will usually cover epi-off corneal cross-linking as it has FDA approval. However, epi-on corneal cross-linking is rarely covered by insurance due to its lack of FDA approval.

Things Not To Do After The Procedure

During the first week after the corneal cross-linking, it is important not to:

Rub and touch your eye/s
Wet your eye/s
Apply eye makeup
Do heavy exercises
Go/stay in dusty and smoky areas

Common Side Effects Of Corneal Cross-Linking

Foreign body sensation
Sensitivity to light
Dry eyes
Blurry vision
Discomfort or pain in the eye

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.