CPT 92019, in plain terms, covers Limited eye examination and evaluation performed under general anesthesia, which can include manipulating the globe to aid the diagnostic exam. CPT 92019 is referenced in 2 tracked payer policy changes from Aetna Better Health of Virginia and Alaska Medicaid. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 92019 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Official descriptor: CPT 92019 on AAPC
Aetna Better Health of Virginia is correcting an error that caused claims to be wrongly denied when E&M services were billed together with specific ophthalmological procedure codes. The payer has removed these codes from the denial trigger list retroactively to July 1, 2025, and will automatically reprocess all affected claims after system updates are complete by February 1, 2026.
Alaska Medicaid clarifies that vision exams are limited to one per calendar year, with additional exams for children requiring medical justification and adults requiring prior authorization. The policy specifies which CPT codes are subject to this limit and outlines required components for covered vision exams.
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Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 92019 in one place.
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