The medical necessity of iLink® corneal cross-linking has become widely recognized.
Reimbursement for Cross-Linking
Insurance coverage for iLink® Corneal Cross-Linking
Learn more about the only FDA-approved cross-linking procedure.
Learn MoreInsurance Coverage for Cross-Linking FAQs
Is iLink® Corneal Cross-Linking covered by insurance?
The medical necessity of iLink® corneal cross-linking has become widely recognized. As a result, more than 95% of the commercially insured population has access to this procedure.
Which Insurance Companies Cover iLink® for the Treatment of Progressive Keratoconus?
If you have questions about insurance policies for iLink® for the treatment of progressive keratoconus, please email your Market Access & Customer Analytics contact or reach out to marketaccess@glaukos.com.
Does insurance cover epi-on procedures?
iLink® is the only FDA-approved product for corneal cross-linking and the procedure is performed epi-off. Many insurance policies have detail about the fact that the epi-off procedure is the only FDA-approved treatment for progressive keratoconus that is being covered, while epi-on is not. See the examples below from Aetna, Cigna, and other insurance coverage policies.
Aetna
“Aetna considers epithelium-off photochemical collagen cross-linkage using riboflavin and ultraviolet A medically necessary for keratoconus and keratectasia. Aetna considers epithelium-on (transepithelial) collagen cross-linkage experimental and investigational for keratoconus, keratectasia, and all other indications.”
Cigna
“Conventional, epithelium-off, corneal collagen crosslinking (C-CXL) using a FDA-approved drug/device system (e.g., Photrexa® Viscous or Photrexa® with the KXL® System) (CPT Code® 0402T; HCPCS Code J3490) is considered medically necessary for the treatment of progressive keratoconus and corneal ectasia following refractive surgery.”
BCBS of MA
“Currently, the only corneal cross-linking treatment approved by the Food and Drug Administration (FDA) is the epithelium-off method. There are no FDA-approved corneal cross-linking treatments using the epithelium-on method.”
Moda Health
“Moda Health considers corneal collagen cross-linking (CXL) medically necessary if the requested procedure is for epithelium-off photochemical collagen cross-linkage using riboflavin (HCPC: J3490- Avedro’s Photrexa) and ultraviolet A.”
SelectHealth
“SelectHealth covers epithelium-off corneal cross-linking once per lifetime if the following criteria are met: The medicine used is Photrexa® Viscous/Photrexa® with the KXL® device.”
Does insurance cover non-FDA-approved products?
Generally, insurance does not cover products and procedures that have not received FDA approval. As an example, the Blue Cross and Blue Shield Association’s Technology Evaluation Center (Premera BCBS Technology Review) states the following as part of their new technology evaluation criteria: “The technology must have final approval from the appropriate governmental regulatory bodies.”
What resources does Glaukos have to support iLink® reimbursement?
iPath360 reimbursement program
The iPath360 is a full-service end-to-end program designed to assist patients who are seeking access and reimbursement for iLink® corneal cross-linking.
Does Photrexa® Viscous and Photrexa® have product specific J-code?
J-code J2787 has been issued by the Centers for Medicare and Medicaid Services for the use of Photrexa® Viscous (riboflavin 5’-phosphate in 20% dextran ophthalmic solution) and Photrexa® (riboflavin 5’-phosphate ophthalmic solution) formulas.
Number of plans that cover iLink® in each state
All 50 states have 6 or more plans that cover iLink® corneal cross-linking.
