Coding and Billing for Keratoconus: Corneal Collagen Crosslinking


Note: Applies to US Only.

Corneal crosslinking (CXL) is an approved procedure for the treatment of progressive keratoconus (KC) and the treatment of corneal ectasia following refractive surgery. e procedure codes that are used to submit CXL claims are 0402T and J2787. CPT code 0402T is a Category III code, CXL of cornea, including removal of the corneal epithelium and intraoperative pachymetry. HCPCS code J2787 is to bill the medication: Riboflavin 5’ – phosphate, ophthalmic solution, up to 3 ml. HCPCS code J2787 requires two units when billing for the medication.

Medical Policy and Insurance Carriers 

Simply knowing how to bill and submit a claim for CXL is not enough. It is important to understand the medical policy of the different insurance carriers to see what documentation is required to show progressive KC. Some policies want to see at least one of the following – an increase of 1.00D in the steepest keratometry value, an increase of 1.00D in regular astigmatism by a sub[1]jective manifest refraction, a myopic shift of 0.50D on subjective manifest refraction, or a decrease > 0.1 mm in the back optical zone radius in rigid contact lens wearers where other information is not available. Some insurance carriers will not cover CXL for ectasia if refractive surgery is not a covered service. It is important to notify the patient what their coverage is or if they will not have any coverage. Having this clearly outlined in your documentation is also very helpful if the insurance company is requesting records.

Understanding the medical policy for the procedure is key. However, knowing what the medical policy is for required testing for the examination is also important. When a patient comes in for their corneal exam, we bill for an oce visit and any necessary testing. Corneal topography is a common test, which is CPT code 92025. Corneal topography[1]phy can be considered medically necessary for patients who need CXL with a diagnosis of corneal ectasia or KC. Coverage for corneal topography may also vary by insurance carrier. There are some carriers that have a different medical policy and only cover it if it is done for the initial diagnosis of KC and for monitoring of the disease when there is a change in vision. We have also seen where some insurance carriers do not cover corneal topography. In this case, a ­financial waiver can be used to notify the patient that they would be financially responsible for the testing. If the charge for corneal topography is denied, a practice could also try to appeal with documentation to see if the insurance company would reconsider their denial.


Once the CXL procedure has been done and the claim has been submitted and paid, it is essential to review the reimbursement. Our team reviews paid claims to ensure they are paid appropriately and according to our contract. If you find that your reimbursement is low, it is important to first verify if the payment is consistent with the contract. You may have a contract that has been in place for years and is out-dated. If that is the case, reach out to the insurance company to discuss this with their contracting department to review the low reimbursement. You may need to set up a peer-to-peer call to work with the medical director. We have had success with explaining what CXL is and comparing the cost of CXL to the cost of a corneal transplant. We also outline the costs associated with the procedure and how their reimbursement compares to other carriers. 

Being aware of the medical policies and monitoring the reimbursements helps set your practice up for success. We have seen that a lot of positive changes take place with crosslinking. It has been an exciting journey with many providers and practices doing their part to help patients get the care they need and being properly reimbursed.