Corneal Crosslinking Reimbursement<br>In Its Tenth Year
Providing crosslinking procedures in an ophthalmology practice is not for the faint of heart. Ultimately, despite its clinical importance, offering crosslinking remains financially challenging for many practices.
By
Laurie Brown, MBA, COMT, COE, CPC, CPMA, LSSYB
Brittney Irwin, COT, CPC, CEP
January 1, 2026
Clinical Scorecard: Corneal Crosslinking Reimbursement In Its Tenth Year
At a Glance
Category Detail
Condition Progressive corneal ectasia including keratoconus and post-LASIK ectasia Key Mechanisms Application of riboflavin solutions and UV-A light to strengthen the cornea via crosslinking Target Population Patients with progressive keratoconus or post-refractive surgery ectasia Care Setting Ophthalmology offices or ambulatory surgery centers
Key Highlights
FDA-approved epi-off corneal crosslinking is widely covered by payers but faces reimbursement challenges. New FDA-approved epi-on procedure (Epioxa) lacks payer coverage due to experimental status and high drug costs. Rising riboflavin drug costs and inconsistent reimbursement threaten financial sustainability of crosslinking programs. Guideline-Based Recommendations
Diagnosis
Identify progressive keratoconus or post-LASIK ectasia as indications for corneal crosslinking. Management
Perform FDA-approved epi-off crosslinking using riboflavin and UV-A light to halt disease progression. Consider epi-on crosslinking (Epioxa) when commercially available and covered by payers. Monitoring & Follow-up
Continuously monitor payer coverage policies and reimbursement rates for crosslinking procedures and drugs. Maintain staff training on documentation and billing to minimize denials and appeals. Risks
Financial risks include rising drug costs, inadequate reimbursement, and administrative hurdles with Category III CPT coding. Limited coverage for new epi-on procedures may delay patient access. Patient & Prescribing Data
Patients with progressive keratoconus or post-refractive surgery ectasia requiring corneal strengthening
Epi-off procedure is FDA approved and covered by most payers; epi-on procedure currently lacks coverage and has substantially higher drug costs.
Clinical Best Practices
Proactively monitor payer policies and reimbursement changes to maintain financial viability. Provide consistent internal staff training on billing and documentation requirements to reduce claim denials. Engage in contract negotiations and preauthorization processes to optimize reimbursement. Evaluate cost-benefit before adopting new technologies like epi-on crosslinking given current coverage limitations. References
