Corneal transplants (keratoplasties) are performed as follows:

• Lamellar keratoplasty (LK), a partial thickness or penetrating keratoplasty (PK), full thickness cornea is removed and replaced with a donor cornea.
• Endothelial keratoplasty (EK, DSEK, DSAEK,DMEK, posterior lamellar keratoplasty) - the diseased inner layer of the cornea, the endothelium, is removed and replaced with healthy donor tissue while keeping the anterior corneal surface intact.

Corneal transplantation may be considered medically necessary for ANY of the following indications:

• Pseudophakic corneal edema; or
• Aphakic corneal edema; or
• Stromal corneal dystrophies; or
• Primary corneal endotheliopathies; or
• Ectasias/thinnings; or
• Congenital opacities; or
• Viral/post-viral keratitis; or
• Microbial/post-microbial keratitis; or
• Noninfectious ulcerative keratitis or perforation; or
• Corneal degenerations; or
• Chemical injuries; or
• Regraft related to allograft rejection; or
• Regraft unrelated to allograft rejection; or
• Steven-Johnson Syndrome; or
• Stromal corneal dystrophies; or
• Trauma or injuries that cause corneal scarring; or
• Viral/post-viral keratitis

Corneal transplantation is considered not medically necessary for indications other than those listed above.

Boston KPro - Artificial Cornea

Keratoprosthesis using the Dohlman Doane Boston KPro ("Boston KPro") device may be considered medically necessary when ALL of the following criteria are met:

• The cornea is severely opaque and vascularized; and
• Cadaveric corneal transplants have failed or there is a very low likelihood of success.

The use of any other artificial cornea device other than the Boston KPro is considered experimental/investigational and, therefore, non-covered because the safety and/or effectiveness of this services cannot be established by the available peer-reviewed literature.

Endothelial Keratoplasty (DSEK, DSAEK, DMEK, DMAEK)

Endothelial keratoplasty (Descemet stripping endothelial keratoplasty [DSEK]), Descemet stripping automated endothelial keratoplasty (DSAEK), Descemet membrane endothelial keratoplasty (DMEK), or Descemet membrane automated endothelial keratoplasty (DMAEK) may be considered medically necessary for the treatment of endothelial dysfunction, including but not limited to ANY of the following indications:

• Ruptures in Descemet membrane; or
• Endothelial dystrophy; or
• Aphakic, and pseudophakic bullous keratopathy; or
• Iridocorneal endothelial (ICE) syndrome; or
• Corneal edema attributed to endothelial failure; and
• Failure or rejection of a previous corneal transplant. 

Endothelial keratoplasty for any indication other than listed above is considered experimental/investigational and, therefore, non-covered because the safety and/or effectiveness of this services cannot be established by the available peer-reviewed literature.

Femtosecond Laser-Assisted Corneal Endothelial Keratoplasty (FLEK)

FLEK or femtosecond and excimer laser assisted endothelial keratoplasty (FELEK) are considered experimental/investigational and, therefore, non-covered because the safety and/or effectiveness of this services cannot be established by the available peer-reviewed literature.