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Clinical Policy Title: Therapeutic contact lenses

Clinical Policy Number: CCP.1077

Effective Date: June 1, 2014

Initial Review Date: December 18, 2013

Most Recent Review Date: February 5, 2019

Next Review Date: February 2020

Related policies:

CCP.1138 Corneal transplants (keratoplasty)

CCP.1257 Corneal implants

ABOUT THIS POLICY: AmeriHealth Caritas has developed clinical policies to assist with making coverage determinations. AmeriHealth Caritas’ clinical policies are based on guidelines from established industry sources, such as the Centers for Medicare & Medicaid Services (CMS), state regulatory agencies, the American Medical Association (AMA), medical specialty professional societies, and peer-reviewed professional literature. These clinical policies along with other sources, such as plan benefits and state and federal laws and regulatory requirements, including any state- or plan-specific definition of “medically necessary,” and the specific facts of the particular situation are considered by AmeriHealth Caritas when making coverage determinations. In the event of conflict between this clinical policy and plan benefits and/or state or federal laws and/or regulatory requirements, the plan benefits and/or state and federal laws and/or regulatory requirements shall control. AmeriHealth Caritas’ clinical policies are for informational purposes only and not intended as medical advice or to direct treatment. Physicians and other health care providers are solely responsible for the treatment decisions for their patients. AmeriHealth Caritas’ clinical policies are reflective of evidence-based medicine at the time of review. As medical science evolves, AmeriHealth Caritas will update its clinical policies as necessary. AmeriHealth Caritas’ clinical policies are not guarantees of payment.

Coverage policy

AmeriHealth Caritas considers the use of therapeutic contact lenses to be clinically proven and, therefore,

medically necessary when all of the following criteria are met (American Academy of Ophthalmology, 2017;

Foulks, 2003; Watson, 2012):

Use of any of the following lens types:

Contact lenses or intra-ocular lenses placed after cataract surgery, as they are

considered prostheses unless otherwise specified by the member’s benefit plan.

Hydrophilic soft contact lenses or gas-permeable fluid ventilated scleral lenses, when

used in the management of severe corneal disease.

Boston scleral lens when used as a moist corneal bandage if lubricants or drops are not

appropriate.

Scleral shell contact lenses for the treatment of severe keratoconjunctivitis sicca and/or

when the orbit requires greater support because of the loss of corneal strength.

Correction of any of the following functional impairments:

Policy contains:

Amniotic membrane

transplantation.

Boston scleral lens.

Hydrophilic contact lens for

corneal bandage.

Scleral shell lens.

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Not able to achieve vision of 20/40 or better, despite best correction with eyeglasses or

typical contact lenses.

Lenses will delay/prevent the need for corneal transplantation.

Will improve performance of activities of daily living.

AmeriHealth Caritas considers the use of amniotic membrane transplantation to be clinically proven and,

therefore, medically necessary on a case-by-case basis for circumstances where there is a severe condition

requiring acute treatment, such as (Clare, 2012; Zhao, 2015):

Chemical, thermal, or radiation injuries.

Stevens Johnson Syndrome.

Limbal stem cell failure.

Limitations:

All other uses of therapeutic contact lenses are not medically necessary.

Contact lenses for vision correction are subject to benefit plans of the individual member.

The use of contact lenses for treatment of visual perceptual dysfunction, such as dyslexia, has not had

consistent results in clinical studies and cannot be considered medically necessary.

For Medicare members only:

For services performed on or after October 1, 2015, amniotic membrane transplantation for ocular

conditions will be considered medically reasonable and necessary for the following indications (L36237):

Failure of standard therapy for severe ophthalmological conditions demonstrated by ocular

surface cell damage or failure and/or inflammation, scarring, or ulceration of the underlying

stroma.

A severe condition requiring acute treatment with amniotic membrane, such as:

Chemical, thermal or radiation injuries.

Stevens Johnson Syndrome.

Limbal stem cell failure.

Band keratopathy after treatment with other therapy, such as:

Surgery.

Topical medications

Bandage contact lens.

Patching.

Bullous keratopathy associated with an epithelial defect.

Scleral melting.

Corneal ulcer following initiation of anti-infective therapy and demonstration of clinical

response for the purpose of healing the persistent epithelial defect.

Conjunctival defects after other therapy, such as surgery or topical medications.

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Corneal melting.

Recurrent corneal erosions after treatment failure with other therapy, such as:

Bandage contact lens.

Patching.

Topical medications.

Limitations for Medicare members only:

Amniotic membrane must have U.S. Food and Drug Administration approval for sutureless applications to

eye.

Application for dry eye syndrome is not medically necessary, given no demonstrated impact on long-term

outcome.

Cogan’s Dystrophy is not covered unless associated with corneal epithelial removal.

Alternative covered services:

Physician office visits.

Standard covered ocular surgery.

Standard medical management of corneal disease.

Background

Therapeutic contact lenses are designed to manage other ocular pathology beyond simple refractive

disorders. There are several types of therapeutic lenses available for the management of these disorders,

consisting of (Gromacki, 2012):

Corneal liquid bandage lens may be rigid gas permeable scleral contact lenses or a therapeutic

contact lens. They are used to treat acute or chronic corneal disease, such as the persistent

epithelial defects listed above. These lenses protect the cornea from the drying effects of air

and may reduce pain and photophobia. Because such lenses cover the entire cornea with a

smooth surface, they may improve vision that results from acute astigmatism.

Boston scleral lens was developed through the Boston Foundation for Sight. It is a specially

designed fluid-ventilated, gas-permeable contact lens. The design allows a bubble-free

reservoir of oxygenated aqueous fluid to cover the corneal surface, at a neutral hydrostatic

pressure. This design makes it well suited for severe corneal diseases.

Scleral shell contact lens covers the entire exposed surface of the eye. For individuals with

severe dry eye, such as keratoconjunctivitis, the scleral shell lens can hold artificial tears that

have been dropped into the eye. These lenses protect the eye against further drying. The

scleral shell also allows support and protection when severe corneal disease has rendered the

person blind. Use of the scleral shell may prevent enucleation by providing support for the rest

of the eye.

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Amniotic membrane transplantation is performed in cases of severe thermal or chemical burns

to the cornea to reduce pain and accelerate healing.

Searches

AmeriHealth Caritas searched PubMed and the databases of:

UK National Health Services Centre for Reviews and Dissemination.

Agency for Healthcare Research and Quality.

The Centers for Medicare & Medicaid Services.

We conducted searches on October 23, 2018. Search terms were: “Contact Lenses/therapeutic use”(MeSH),

“Contact Lenses, Extended-Wear/therapeutic use”(MeSH), “therapeutic contact lenses,” and “amniotic

membrane.”

We included:

Systematic reviews, which pool results from multiple studies to achieve larger sample sizes and

greater precision of effect estimation than in smaller primary studies. Systematic reviews use

predetermined transparent methods to minimize bias, effectively treating the review as a

scientific endeavor, and are thus rated highest in evidence-grading hierarchies.

Guidelines based on systematic reviews.

Economic analyses, such as cost-effectiveness, and benefit or utility studies (but not simple

cost studies), reporting both costs and outcomes — sometimes referred to as efficiency studies

— which also rank near the top of evidence hierarchies.

Findings

Most studies on the various medical uses of contact lenses have been single site, with relatively small

numbers enrolled. We found no recent meta-analyses of therapeutic contact lenses or head-to-head

comparisons between the various products. Reviews of studies of amniotic membrane transplantation have

not found sufficient evidence from published, peer-reviewed articles to support its routine use (Clare,

2012).

Professional guidelines note the absence of such studies and recommend that the professional describe the

advantages of various strategies, thus allowing the patient to be an active participant in the clinical

judgment (American Academy of Ophthalmology, 2017). There is consensus that patients with corneal

pathology that threatens to weaken the architecture of the eye should be treated with appropriate medical

therapy and/or supporting contact lenses. The corneal disorders for which contact lenses may become

therapeutic include the following conditions:

Aphakia.

Prostheses following cataract surgery.

Stevens-Johnson syndrome, toxic epidermolysis necrosis, chemical burns, or other corneal stem

cell deficiencies.

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Congenital anomalies.

Neurotrophic corneas.

Keratoconjunctivitis with reduced tear production.

Corneal involvement of systemic autoimmune disorders.

Corneal exposure disorders.

Epidermal ocular disorders.

Keratoconus associated with irregular astigmatism.

Policy updates:

We found one new systematic review that addressed ex vivo cultured limbal epithelial transplantation with

amniotic membrane transplantation for the treatment of limbal stem cell deficiency (Zhao, 2015). We

found one ongoing clinical trial of amniotic membrane transplantation that has been in progress since the

year 2000, but has not been verified since 2008, and no published results of the study are available

(ClinicalTrials.gov identifier: NCT00344708). Since the last review date of this policy, the American Academy

of Ophthalmology has updated three Preferred Practice Pattern guidelines: corneal edema and

opacification (2015a); corneal ectasia (2015b); and dry eye syndrome (2015c). The new information does

not impact the results of the original clinical policy. Therefore, no changes to the policy are warranted.

In 2018, we added the results of a Cochrane review (Clearfield, 2016) and updated, consolidated guidance

from the American Academy of Ophthalmology (2017). Clearfield et al found that conjunctival autograft

surgery was associated with a lower risk of pterygium recurrence at six months compared to amniotic

membrane transplantation, but additional research is needed to determine which type of surgery resulted

in better vision or quality of life. The American Academy of Ophthalmology (2017) guidance has not

changed. No policy changes are warranted at this time.

In 2019, we added one Cochrane review update of treatments for recurrent corneal erosion to the findings

(Watson, 2018) with no changes to its original conclusions for therapeutic contact lens. No policy changes

are warranted. Policy ID changed from CP# 10.02.02 to CCP.1077.

References

Professional society guidelines/other:

American Academy of Ophthalmology. Preferred Practice Pattern Panels. Summary Benchmarks – Full Set –

November 2017. American Academy of Ophthalmology website. https://www.aao.org/summary-

benchmark-detail/summary-benchmarks-full-set-2017. Accessed October 23, 2018.

American Academy of Pediatrics, Section on Ophthalmology, Council on Children with Disabilities, American

Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus and

American Association of Certified Orthoptists. Learning Disabilities, Dyslexia, and Vision. Pediatrics 2009

Aug; 124(2); 837 – 844. Also available at: http://pediatrics.aappublications.org/content/124/2/837.long.

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Accessed October 23, 2018.

Gromacki, S. The Case for Bandage Soft Contact Lenses. Review of Cornea and Contact Lenses website.

http://www.reviewofcontactlenses.com/article/the-case-for-bandage-soft-contact-lenses. Published

January 25, 2012. Accessed December 21, 2018.

Peer-reviewed references:

Clare G, Suleman H, Bunce C, Dua H. Amniotic membrane transplantation for acute ocular burns. Cochrane

Database Syst Rev. 2012 Sep 12;9:CD009379. Doi: 10.1002/14651858.CD009379.pub2.

Clearfield E, Muthappan V, Wang X, Kuo IC. Conjunctival autograft for pterygium. Cochrane Database Syst

Rev. 2016;2:Cd011349. Doi: 10.1002/14651858.CD011349.pub2.

Foulks GN, Harvey T, Raj CV. Therapeutic contact lenses: the role of high-DK lenses. Ophthalmol Clin North

Am. 2003 Sep;16(3):455-461. Doi: 10.1016/S0896-1549(03)00053-1.

Watson SL, Lee MH, Barker NH. Interventions for recurrent corneal erosions. Cochrane Database of Sys

Rev. 2018;7:CD001861. Doi: 10.1002/14651858.CD001861.pub3.

Zhao Y, Ma L. Systematic review and meta-analysis on transplantation of ex vivo cultivated limbal epithelial

stem cell on amniotic membrane in limbal stem cell deficiency. Cornea. 2015;34(5):592-600. Doi:

10.1097/ico.0000000000000398.

Centers for Medicare & Medicaid Services National Coverage Determinations:

80.1 Hydrophilic Contact Lens for Corneal Bandage.

80.4 Hydrophilic Contact Lenses.

80.5 Scleral Shell.

Local Coverage Determinations:

L36237 Amniotic Membrane- Sutureless Placement on the Ocular Surface.

L36232 Diagnostic Evaluation and Medical Management of Moderate-Severe Dry Eye Disease (DED).

Commonly submitted codes

Below are the most commonly submitted codes for the service(s)/item(s) subject to this policy. This is not

an exhaustive list of codes. Providers are expected to consult the appropriate coding manuals and bill

accordingly.

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CPT Code Description Comments

92071 Fitting of contact lens for treatment of ocular surface disease

92072 Fitting of contact lens for management of keratoconus; initial fitting

92310

Prescription of optical and physical characteristics of and fitting of contact lens,

with medical supervision of adaptation, corneal lens, both eyes, except for

aphakia

92311 Prescription of optical and physical characteristics of and fitting of contact lens,

with medical supervision of adaptation; corneal lens for aphakia, 1 eye

92312 Prescription of optical and physical characteristics of and fitting of contact lens,

with medical supervision of adaptation; corneal lens for aphakia, both eyes

92313 Prescription of optical and physical characteristics of and fitting of contact lens,

with medical supervision of adaptation; corneoscleral lens

92314

Prescription of optical and physical characteristics of contact lens, with medical

supervision of adaptation and direction of fitting by independent technician;

corneal lens, both eyes except for aphakia

92315

Prescription of optical and physical characteristics of contact lens, with medical

supervision of adaptation and direction of fitting by independent technician;

corneal lens for aphakia, 1 eye

92316

Prescription of optical and physical characteristics of contact lens, with medical

supervision of adaptation and direction of fitting by independent technician;

corneal lens for aphakia, both eyes

92317

Prescription of optical and physical characteristics of contact lens, with medical

supervision of adaptation and direction of fitting by independent technician;

corneoscleral lens

ICD-10 Code Description Comments

B55.2 Mucocutaneous leishmaniasis

H02.051 Trichiasis without entropian right upper eyelid

H02.052 Trichiasis without entropian right lower eyelid

H02.053 Trichiasis without entropian right eye, unspecified eyelid

H02.054 Trichiasis without entropian left upper eyelid

H02.055 Trichiasis without entropian left lower eyelid

H02.056 Trichiasis without entropian left eye, unspecified eyelid

H02.059 Trichiasis without entropian unspecified eye, unspecified eyelid

H02.89 Other specified disorders of eyelid

H02.9 Unspecified disorder of eyelid

H04.121 Dry eye syndrome of right lacrimal gland

H04.122 Dry eye syndrome of left lacrimal gland

H04.123 Dry eye syndrome of bilateral lacrimal glands

H04.129 Dry eye syndrome of unspecified lacrimal gland

H04.141 Primary lacrimal gland atrophy, right lacrimal gland

H04.142 Primary lacrimal gland atrophy, left lacrimal gland

H04.143 Primary lacrimal gland atrophy, bilateral lacrimal glands

H04.149 Primary lacrimal gland atrophy, unspecified lacrimal gland

H04.151 Secondary lacrimal gland atrophy, right lacrimal gland

H04.152 Secondary lacrimal gland atrophy, left lacrimal gland

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ICD-10 Code Description Comments

H04.153 Secondary lacrimal gland atrophy, bilateral lacrimal glands

H04.159 Secondary lacrimal gland atrophy, unspecified lacrimal gland

H04.69 Other changes of lacrimal passages

H10.211 Acute toxic conjunctivitis, right eye

H10.212 Acute toxic conjunctivitis, left eye

H10.213 Acute toxic conjunctivitis, bilateral

H10.219 Acute toxic conjunctivitis, unspecified eye

H10.89 Other conjunctivitis

H11.241 Scarring of conjunctiva, right eye

H11.242 Scarring of conjunctiva, left eye

H11.243 Scarring of conjunctiva, bilateral

H11.249 Scarring of conjunctiva, unspecified eye

H16.121 Filamentary keratitis, right eye

H16.122 Filamentary keratitis, left eye

H16.123 Filamentary keratitis, bilateral

H16.129 Filamentary keratitis, unspecified eye

H16.141 Punctate keratitis, right eye

H16.142 Punctate keratitis, left eye

H16.143 Punctate keratitis, bilateral

H16.149 Punctate keratitis, unspecified eye

H16.211 Exposure keratoconjunctivitis, right eye

H16.212 Exposure keratoconjunctivitis, left eye

H16.213 Exposure keratoconjunctivitis, bilateral

H16.219 Exposure keratoconjunctivitis, unspecified eye

H16.221 Keratoconjunctivitis sicca, not specified as Sjogren's, right eye

H16.222 Keratoconjunctivitis sicca, not specified as Sjogren's, left eye

H16.223 Keratoconjunctivitis sicca, not specified as Sjogren's, bilateral

H16.229 Keratoconjunctivitis sicca, not specified as Sjogren's, unspecified eye

H16.231 Neurotrophic keratoconjunctivitis, right eye

H16.232 Neurotrophic keratoconjunctivitis, left eye

H16.233 Neurotrophic keratoconjunctivitis, bilateral

H16.239 Neurotrophic keratoconjunctivitis, unspecified eye

H16.261 Vernal keratoconjunctivitis, with limbar and corneal involvement, right eye

H16.262 Vernal keratoconjunctivitis, with limbar and corneal involvement, left eye

H16.263 Vernal keratoconjunctivitis, with limbar and corneal involvement, bilateral

H16.269 Vernal keratoconjunctivitis, with limbar and corneal involvement, unspecified

eye

H16.291 Other keratoconjunctivitis, right eye

H16.292 Other keratoconjunctivitis, left eye

H16.293 Other keratoconjunctivitis, bilateral

H16.299 Other keratoconjunctivitis, unspecified eye

H18.10 Bullous keratopathy, unspecified eye

H18.11 Bullous keratopathy, right eye

H18.12 Bullous keratopathy, left eye

H18.13 Bullous keratopathy, bilateral

H18.40 Unspecified corneal degeneration

H18.411 Arcus senilis, right eye

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ICD-10 Code Description Comments

H18.412 Arcus senilis, left eye

H18.413 Arcus senilis, bilateral

H18.419 Arcus senilis, unspecified eye

H18.421 Band keratopathy, right eye

H18.422 Band keratopathy, left eye

H18.423 Band keratopathy, bilateral

H18.429 Band keratopathy, unspecified eye

H18.43 Other calcerous corneal degeneration

H18.441 Keratomalacia, right eye

H18.442 Keratomalacia, left eye

H18.443 Keratomalacia, bilateral

H18.449 Keratomalacia, unspecified eye

H18.451 Nodular corneal degeneration, right eye

H18.452 Nodular corneal degeneration, left eye

H18.453 Nodular corneal degeneration, bilateral

H18.459 Nodular corneal degeneration, unspecified eye

H18.461 Peripheral corneal degeneration, right eye

H18.462 Peripheral corneal degeneration, left eye

H18.463 Peripheral corneal degeneration, bilateral

H18.469 Peripheral corneal degeneration, unspecified eye

H18.49 Other corneal degeneration

H18.51 Endothelial corneal dystrophy

H18.53 Granular corneal dystrophy

H18.54 Lattice corneal dystrophy

H18.55 Macular corneal dystrophy

H18.59 Other hereditary corneal dystrophies

H18.601 Keratoconus, unspecified, right eye

H18.602 Keratoconus, unspecified, left eye

H18.603 Keratoconus, unspecified, bilateral

H18.609 Keratoconus, unspecified, unspecified eye

H18.611 Keratoconus, stable, right eye

H18.612 Keratoconus, stable, left eye

H18.613 Keratoconus, stable, bilateral

H18.619 Keratoconus, stable, unspecified eye

H18.621 Keratoconus, unstable, right eye

H18.622 Keratoconus, unstable, left eye

H18.623 Keratoconus, unstable, bilateral

H18.629 Keratoconus, unstable, unspecified eye

H18.711 Corneal ectasia, right eye

H18.712 Corneal ectasia, left eye

H18.713 Corneal ectasia, bilateral

H18.719 Corneal ectasia, unspecified eye

H18.731 Descemetocele, right eye

H18.732 Descemetocele, left eye

H18.733 Descemetocele, bilateral

H18.739 Descemetocele, unspecified eye

H18.831 Recurrent erosion of cornea, right eye

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ICD-10 Code Description Comments

H18.832 Recurrent erosion of cornea, left eye

H18.833 Recurrent erosion of cornea, bilateral

H18.839 Recurrent erosion of cornea, unspecified eye

L12.1 Cicatricial pemphigoid

L12.30 Acquired epidermolysis bullosa, unspecified

L12.31 Epidermolysis bullosa due to drug

L12.35 Other acquired epidermolysis bullosa

L51.0 Nonbullous erythema multiforme

L51.1 Stevens-Johnson syndrome

L51.2 Toxic epidermal necrolysis [Lyell]

L51.3 Stevens-Johnson syndrome-toxic epidermal necrolysis overlap syndrome

L51.8 Other erythema multiforme

L51.9 Erythema multiforme, unspecified

M35.00 Sicca syndrome, unspecified

M35.01 Sicca syndrome with keratoconjunctivitis

M35.02 Sicca syndrome with lung involvement

M35.03 Sicca syndrome with myopathy

M35.04 Sicca syndrome with tubulo-interstitial nephropa

M35.09 Sicca syndrome with other organ involvement

Q10.0 Congenital ptosis

Q10.1 Congenital ectropion

Q10.2 Congenital entropion

Q10.3 Other congenital malformations of eyelid

Q10.4 Absence and agenesis of lacrimal apparatus

Q10.5 Congenital stenosis and stricture of lacrimal duct

Q10.6 Other congenital malformations of lacrimal apparatus

S00.201A Unspecified superficial injury of right eyelid and periocular area, initial encounter

S00.202A Unspecified superficial injury of left eyelid and periocular area, initial encounter

S00.209A Unspecified superficial injury of unspecified eyelid and periocular area, initial

encounter

S00.211A Abrasion of right eyelid and periocular area, initial encounter

S00.212A Abrasion of left eyelid and periocular area, initial encounter

S00.219A Abrasion of unspecified eyelid and periocular area, initial encounter

S00.221A Blister (nonthermal) of right eyelid and periocular area, initial encounter

S00.222A Blister (nonthermal) of left eyelid and periocular area, initial encounter

S00.229A Blister (nonthermal) of unspecified eyelid and periocular area, initial encounter

S00.241A External constriction of right eyelid and periocular area, initial encounter

S00.242A External constriction of left eyelid and periocular area, initial encounter

S00.249A External constriction of unspecified eyelid and periocular area, initial encounter

S00.251A Superficial foreign body of right eyelid and periocular area, initial encounter

S00.252A Superficial foreign body of left eyelid and periocular area, initial encounter

S00.259A Superficial foreign body of unspecified eyelid and periocular area, initial

encounter

S00.261A Insect bite (nonvenomous) of right eyelid and periocular area, initial encounter

S00.262A Insect bite (nonvenomous) of left eyelid and periocular area, initial encounter

S00.269A Insect bite (nonvenomous) of unspecified eyelid and periocular area, initial

encounter

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ICD-10 Code Description Comments

S00.271A Other superficial bite of right eyelid and periocular area, initial encounter

S00.272A Other superficial bite of left eyelid and periocular area, initial encounter

S00.279A Other superficial bite of unspecified eyelid and periocular area, initial encounter

S05.00XA Injury of conjunctiva and corneal abrasion without foreign body, unspecified

eye, initial encounter

S05.01XA Injury of conjunctiva and corneal abrasion without foreign body, right eye, initial

encounter

S05.02XA Injury of conjunctiva and corneal abrasion without foreign body, left eye, initial

encounter

S05.20XA Ocular laceration and rupture with prolapse or loss of intraocular tissue,

unspecified eye, initial encounter

S05.21XA Ocular laceration and rupture with prolapse or loss of intraocular tissue, right

eye, initial encounter

S05.22XA Ocular laceration and rupture with prolapse or loss of intraocular tissue, left eye,

initial encounter

S05.30XA Ocular laceration without prolapse or loss of intraocular tissue, unspecified eye,

initial encounter

S05.31XA Ocular laceration without prolapse or loss of intraocular tissue, right eye, initial

encounter

S05.32XA Ocular laceration without prolapse or loss of intraocular tissue, left eye, initial

encounter

S05.50XA Penetrating wound with foreign body of unspecified eyeball, initial encounter

S05.51XA Penetrating wound with foreign body of right eyeball, initial encounter

S05.52XA Penetrating wound with foreign body of left eyeball, initial encounter

S05.60XA Penetrating wound without foreign body of unspecified eyeball, initial encounter

S05.61XA Penetrating wound without foreign body of right eyeball, initial encounter

S05.62XA Penetrating wound without foreign body of left eyeball, initial encount

S05.70XA Avulsion of unspecified eye, initial encounter

S05.71XA Avulsion of right eye, initial encounter

S05.72XA Avulsion of left eye, initial encounter

S05.8X1A Other injuries of right eye and orbit, initial encounter

S05.8X2A Other injuries of left eye and orbit, initial encounter

S05.8X9A Other injuries of unspecified eye and orbit, initial encounter

S05.90XA Unspecified injury of unspecified eye and orbit, initial encounter

S05.91XA Unspecified injury of right eye and orbit, initial encounter

S05.92XA Unspecified injury of left eye and orbit, initial encounter

T26.10XA Burn of cornea and conjunctival sac, unspecified eye, initial encounter

T26.11XA Burn of cornea and conjunctival sac, right eye, initial encounter

T26.12XA Burn of cornea and conjunctival sac, left eye, initial encounter

T26.60XA Corrosion of cornea and conjunctival sac, unspecified eye, initial encounter

T26.61XA Corrosion of cornea and conjunctival sac, right eye, initial encounter

T26.62XA Corrosion of cornea and conjunctival sac, left eye, initial encounter

Z94.7 Corneal transplant status

HCPCS

Level II Code Description Comments

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S0515 Scleral lens, liquid bandage device, per lens

V2530 Contact lens, scleral, gas impermeable, per lens

V2531 Contact lens, scleral, gas permeable, per lens