TL;DR: Aetna, a CVS Health company, modified CPB 0023 covering corneal remodeling procedures, effective September 26, 2025. Here's what billing teams need to know before claims go out the door.
CPB 0023 Aetna governs coverage for a wide range of corneal remodeling procedures — from collagen cross-linking (CPT 0402T) to corneal transplants (CPT 65710, 65730, 65756) to intrastromal ring segment implantation (CPT 65785). This update affects ophthalmology billing teams, ASC coders, and any revenue cycle team processing Aetna claims for corneal procedures. The covered code list runs deep, but so does the not-covered list — and the line between the two matters a lot for your claim denial rate.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | Aetna, a CVS Health company |
| Policy | Corneal Remodeling — CPB 0023 |
| Policy Code | CPB 0023 |
| Change Type | Modified |
| Effective Date | September 26, 2025 |
| Impact Level | High |
| Specialties Affected | Ophthalmology, ASCs, Optometry (surgical referrals) |
| Key Action | Audit your charge capture for CPT 0402T, 65710, 65730, 65756, 65785, and the three not-covered codes (65765, 66985, and lens removal codes) before billing Aetna claims dated on or after September 26, 2025 |
Aetna Corneal Remodeling Coverage Criteria and Medical Necessity Requirements 2025
The Aetna corneal remodeling coverage policy under CPB 0023 splits procedures into three buckets: covered when selection criteria are met, not covered for listed indications, and related codes that sit in a gray zone. Your team needs to know which bucket each procedure falls into before submitting a claim.
The covered procedures include some of the most common corneal surgeries billed today. CPT 0402T (collagen cross-linking of the cornea, including epithelial removal and intraoperative pacing) is covered when medical necessity criteria are met. The same applies to the keratoplasty family — CPT 65710 (anterior lamellar), CPT 65730 (penetrating, non-aphakic/non-pseudoaphakic), CPT 65756 (endothelial), and CPT 65757 (backbench preparation of corneal endothelial allograft). These are workhorse codes in corneal surgery billing, and Aetna will cover them — but only when the clinical criteria are satisfied and documented.
Also in the covered group: CPT 65767 (epikeratoplasty), CPT 65771 (radial keratotomy), CPT 65772 (corneal relaxing incision for surgically induced astigmatism), CPT 65775 (corneal wedge resection for surgically induced astigmatism), and CPT 65785 (implantation of intrastromal corneal ring segments). Each of these carries the same conditional language — covered if selection criteria are met. That phrase is doing a lot of work. It means your documentation has to connect the clinical picture directly to Aetna's published medical necessity criteria for that specific procedure.
Medical necessity documentation is the linchpin here. If the chart doesn't show why the procedure was the appropriate treatment for that patient's specific condition, you're looking at a claim denial. Pull the full CPB 0023 policy text and confirm your clinical documentation maps to Aetna's stated criteria — especially for the cross-linking code 0402T, which has historically faced scrutiny.
Prior authorization requirements for corneal remodeling procedures under Aetna vary by plan. Check the member's specific plan benefits before scheduling any procedure on this list. Don't assume the policy coverage status equals automatic prior auth approval — those are two separate tracks.
Aetna Corneal Remodeling Exclusions and Non-Covered Indications
Three procedure codes are explicitly not covered for the indications listed in CPB 0023. This is where claim denials concentrate.
CPT 65765 (keratophakia) is not covered. Neither is CPT 66840 (removal of lens material, aspiration technique, one or more stages) nor CPT 66940 (extracapsular lens removal, other than 66840, 66850, 66852). CPT 66985 (secondary intraocular lens prosthesis insertion, not associated with concurrent cataract surgery) is also in the not-covered group.
The real issue here is that these codes can appear on the same operative report as covered corneal procedures. A combined case that includes CPT 65756 (covered) and CPT 66985 (not covered) will likely generate a partial denial if your team isn't splitting the claim correctly. Review your bundling logic before the September 26, 2025 effective date.
Coverage Indications at a Glance
| Procedure | Status | Primary CPT Code(s) | Notes |
|---|---|---|---|
| Collagen cross-linking of cornea | Covered (criteria-based) | 0402T | Includes epithelial removal; document medical necessity carefully |
| Anterior lamellar keratoplasty | Covered (criteria-based) | 65710 | Prior auth — verify per plan |
| Penetrating keratoplasty (non-aphakic/non-pseudoaphakic) | Covered (criteria-based) | 65730 | Prior auth — verify per plan |
| Endothelial keratoplasty | Covered (criteria-based) | 65756 | Often paired with 65757 |
| Backbench preparation of corneal endothelial allograft | Covered (criteria-based) | 65757 | List separately in addition to primary transplant code |
| Epikeratoplasty | Covered (criteria-based) | 65767 | Rarely billed; confirm plan benefits |
| Radial keratotomy | Covered (criteria-based) | 65771 | Verify refractive exclusions in plan language |
| Corneal relaxing incision (surgically induced astigmatism) | Covered (criteria-based) | 65772 | Distinguish from primary refractive correction |
| Corneal wedge resection (surgically induced astigmatism) | Covered (criteria-based) | 65775 | Same distinction applies as 65772 |
| Intrastromal corneal ring segment implantation | Covered (criteria-based) | 65785 | Keratoconus indication most common; document progression |
| Keratophakia | Not Covered | 65765 | Listed exclusion in CPB 0023 |
| Lens material removal (aspiration technique) | Not Covered | 66840 | Not covered for corneal remodeling indications |
| Extracapsular lens removal | Not Covered | 66940 | Same exclusion basis |
| Secondary IOL insertion (not concurrent with cataract) | Not Covered | 66985 | Not covered for indications in CPB 0023 |
Aetna Corneal Remodeling Billing Guidelines and Action Items 2025
| # | Action Item |
|---|---|
| 1 | Audit your charge capture for all corneal procedure codes now. The effective date is September 26, 2025. Any claim dated on or after that date falls under the modified policy. Pull your last 90 days of corneal claims and confirm each code is in the right bucket. |
| 2 | Flag CPT 0402T (collagen cross-linking) for documentation review. This code gets denied when the clinical rationale isn't explicit. The op note and pre-op evaluation should spell out why cross-linking was medically necessary — corneal progression metrics, patient age, and prior treatment history all matter. |
| 3 | Remove CPT 65765, 66840, 66940, and 66985 from any corneal remodeling claim going to Aetna. These are hard exclusions under CPB 0023. If they appear on a combined case, bill them separately and expect a denial — then use that denial strategically if you believe the clinical facts support an appeal. |
| 4 | Verify prior authorization for all covered procedures before scheduling. Covered doesn't mean pre-authorized. Your scheduler and authorization team need to know that CPT 65710, 65730, 65756, 65767, 65771, 65772, 65775, and 65785 all carry coverage criteria that Aetna's authorization team will review. One missed auth is a preventable denial. |
| 5 | Check the "other CPT codes related to the CPB" group for coding crossover. CPB 0023 includes a large set of cornea excision, lesion removal, and cryotherapy codes in the 65400–65465 range as related codes. These aren't explicitly covered or excluded — they're contextual. If your team bills any of those codes alongside a primary corneal remodeling procedure, confirm the combination doesn't trigger a bundling edit or a medical necessity conflict under Aetna's claim adjudication logic. |
| 6 | Talk to your compliance officer if your practice does combined corneal and lens procedures. The overlap between covered corneal codes and the not-covered lens codes (66840, 66940, 66985) creates real exposure on complex cases. If you're not sure how CPB 0023 applies to your specific case mix, get a compliance review before the September 26, 2025 effective date. |
| Previous Version | Current Version |
|---|---|
| Coverage is considered experimental and investigational for all indications | Coverage is considered medically necessary when specific criteria are met |
| Prior authorization is not required | Prior authorization is required for initial treatment |
| Documentation must include clinical history | Documentation must include clinical history |
| Re-review every 24 months | Re-review every 12 months with updated clinical documentation |
CPT, HCPCS, and ICD-10 Codes for Corneal Remodeling Under CPB 0023
Covered CPT Codes (When Selection Criteria Are Met)
| Code | Type | Description |
|---|---|---|
| 0402T | CPT | Collagen cross-linking of cornea, including removal of the corneal epithelium and intraoperative pacing |
| 65710 | CPT | Keratoplasty (corneal transplant); anterior lamellar |
| 65730 | CPT | Keratoplasty (corneal transplant); penetrating (except in aphakia or pseudoaphakia) |
| 65756 | CPT | Keratoplasty (corneal transplant); endothelial |
| 65757 | CPT | Backbench preparation of corneal endothelial allograft prior to transplantation (list separately in addition to code for primary procedure) |
| 65767 | CPT | Epikeratoplasty |
| 65771 | CPT | Radial keratotomy |
| 65772 | CPT | Corneal relaxing incision for correction of surgically induced astigmatism |
| 65775 | CPT | Corneal wedge resection for correction of surgically induced astigmatism |
| 65785 | CPT | Implantation of intrastromal corneal ring segments |
Not Covered CPT Codes (for Indications Listed in CPB 0023)
| Code | Type | Description | Reason |
|---|---|---|---|
| 65765 | CPT | Keratophakia | Not covered for indications listed in CPB 0023 |
| 66840 | CPT | Removal of lens material; aspiration technique, one or more stages | Not covered for indications listed in CPB 0023 |
| 66940 | CPT | Extracapsular lens removal (other than 66840, 66850, 66852) | Not covered for indications listed in CPB 0023 |
| 66985 | CPT | Insertion of intraocular lens prosthesis (secondary implant), not associated with concurrent cataract surgery | Not covered for indications listed in CPB 0023 |
Other CPT Codes Related to CPB 0023
These codes appear in the policy as contextually related. They are not explicitly covered or excluded on their own — coverage depends on the clinical context and the primary procedure being billed.
| Code | Type | Description |
|---|---|---|
| 65400–65465 | CPT | Cornea excision, removal or destruction, or cryotherapy of lesion on cornea (range) |
Note: The full CPB 0023 policy lists 241 CPT codes, 515 HCPCS codes, and 613 ICD-10-CM codes. The codes above reflect the explicitly categorized covered and not-covered codes from the policy data. Your billing team should pull the complete code list from the Aetna CPB 0023 source document to confirm all applicable diagnosis codes for each procedure before billing.
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