Blue Cross and Blue Shield of Texas (BCBSTX) would like to introduce to Ophthalmologists a new predetermination process specifically for corneal transplants.  This process resulted from a physician's suggestion and BCBSTX's concern for the time sensitive nature of corneal transplant procedures. Now available is a specific predetermination process for CPT^® codes 65710 through 65757.

This process includes the use of a specialized predetermination form for corneal transplants.  The form and documentation may be scanned and emailed or faxed to a dedicated area at BCBSTX. Once BCBSTX has received the completed predetermination form, your office will be notified and if any additional documentation will be needed to complete the predetermination process, your office will be notified at this time. You will receive prompt notification by email or fax (per your request) following the completion of the review.

The following information has been specifically designed for the predetermination process of corneal transplants: 

• Corneal Transplant Predetermination Request Form
• Instructions for using the form
• Specific medical criteria for coverage may be found in BCBSTX's medical policy guidelines for Medical Policy SUR713.001 – "Refractive and Therapeutic Keratoplasty."
• Email address and Fax number
  • Email: Corneal Transplant/TX/HCSC@HCSC
  • Fax: (972) 437-0315

The predetermination does not include:

• Confirmation of benefits (please obtain prior to submission by calling BCBSTX Provider Customer Service at 1-800-451-0287).
• Reviews for BlueCard members (out-of-state plans).
• Referrals for members whose contract requires a referral from their Primary Care Physician (PCP) to a Specialty Care Physician (SCP).

Should you have additional questions, please send to email address or fax number listed above. 

 posted 09/2009