BlueCross BlueShield of Tennessee Medical Policy Manual

Ophthalmology

• Aflibercept

• Blepharoplasty

• Browplasty

• Corneal Endothelial Microscopy

• Corneal Topography/Computer-Assisted Photokeratoscopy

• Endothelial Keratoplasty

• Epiretinal Radiation Therapy for Age-Related Macular Degeneration (ARMD)

• Intrastromal Corneal Ring Segments (ICRS) for Vision Correction

• Keratoprosthesis

• LASIK (laser in situ keratomileusis)

• Occipital Nerve Stimulation

• Ocular Photoscreening in the Primary Care Physician's Office as a Screening Tool to Detect Amblyogenic Factors

• Orthoptic Training for the Treatment of Vision or Learning Disabilities

• Retinal Prosthesis

• Retinal Telescreening for Diabetic Retinopathy

• Suprachoroidal Delivery of Pharmacologic Agents

• Transciliary Fistulization for the Treatment of Glaucoma

• Transpupillary Thermotherapy (TTT)

• Visual and Auditory Evoked Potentials

• Visual Impairment Screening for Medical Diseases or Injury

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