Insurance Coverage for Cross-Linking
Insurance coverage for iLink™ Corneal Cross-Linking
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.
Insurance Coverage for Cross-Linking FAQs
Get answers to some of the most common questions surrounding insurance coverage for the iLink™ corneal cross-linking procedure.
Which Insurance Companies Cover iLink™ for the Treatment of Progressive Keratoconus?
This list includes parent companies and their subsidiaries. This list is subject to change. It is not intended to be a directive, nor is it a suggestion about the likelihood of coverage or reimbursement. Not all information may be the most current or up-to-date. Please confirm with your individual carriers. Reimbursement information provided herein is gathered from 3rd-party sources and is presented for illustrative purposes only. This information does not constitute legal or reimbursement advice. Glaukos makes no representation or warranty regarding this information or its completeness, accuracy, timeliness, or applicability with any particular patient. Glaukos specifically disclaims liability or responsibility for the results or consequences of any actions taken in reliance on information in this document. Glaukos encourages providers to submit accurate and appropriate claims for services. Laws, regulations, and payer policies concerning reimbursement are complex and change frequently. Providers are responsible for making appropriate decisions related to coding and reimbursement submissions. Accordingly, Glaukos recommends that customers consult with their payers, reimbursement specialists, and/or legal counsel regarding coding, coverage, and reimbursement matters.
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 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.”
“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 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 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.
iLink™ copay savings program
Eligible patients can receive up to $100 towards their copay expenses. This program is open to anyone with commercial insurance coverage. As is typical of co-pay programs, those who are a government beneficiary and/or participant in a federal or state-funded health insurance program (e.g., Medicare, Medicare Advantage, Medigap, Medicaid, VA, DoD, TRICARE) are not eligible, as mandated by government guidelines.
Patients can enroll in the iLink™ copay savings program by downloading the patient application below.
The iLink™ Copay Savings Program (The Program) is sponsored by Glaukos. Glaukos’s mission is to transform the treatment of chronic eye diseases with novel therapies that provide sustainable solutions to important clinical needs.
*The iLink™ Copay Savings Program covers copays related to the performance of the FDA approved corneal cross- linking procedure with Photrexa® drug formulations up to $100. The maximum payment under the program is $100.
The patient or their guardian must be 18 years or older for the patient to be eligible. This Program is only valid in the United States and U.S. Territories. This Program is void where prohibited by law. This offer cannot be combined with other offers. Not valid for copays that are not related to the FDA approved corneal cross-linking procedure with Photrexa® drug formulations [Photrexa® Viscous (riboflavin 5’-phosphate in 20% dextran ophthalmic solution), Photrexa® (riboflavin 5’-phosphate ophthalmic solution)] and the KXL® System that slows or halts the progression of keratoconus. Receipts must clearly state that the copays were for the corneal cross-linking procedure with Photrexa® drug formulations.
The Explanation of Benefits (EOB) Form you receive from your insurance provider should show both the professional fee and pharmaceutical fee associated with your procedure. Legally, the copay voucher can only apply to your out of pocket expenses related to the pharmaceutical fee. Your EOB form should show J2787 and 0402T. The J code is for the Photrexa® drug formulations. Your copay related to this code will be eligible for reimbursement. The T code is related to your physician’s time during the procedure and is not eligible for reimbursement as part of this program.
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.
iLink™ reimbursement resources
Legal, financial issues need to be considered before implementing new technology (Part 1)
Allison W. Shuren, JD, MSN; Bryant M. Godfrey, JD, MHA; John McInnes, MD, JD