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PAYER POLICY CHANGES

92274 Insurance Policy Changes

CPT 92274, in plain terms, covers A specialized eye test measuring electrical responses from different parts of the retina to check for vision problems. CPT 92274 is referenced in 4 tracked payer policy changes from Aetna Better Health of Virginia and Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 92274 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 92274 on AAPC

Watch 92274

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REFERENCE DATA

Payers with rules5
Payers requiring prior auth5
  • Ambetter · Effective December 31, 2025

    Prior authorization required

    Ambetter Health of Delaware CMS-0057-F prior authorization requirements

  • CalViva Health · Effective December 31, 2025

    Prior authorization required

    CalViva Health CMS-0057-F prior authorization requirements

  • Centene · Effective December 31, 2025

    Prior authorization required

    Sunshine Health Title XIX, Title XXI, Managed Medical Assistance CMS-0057-F prior authorization requirements

FREQUENTLY ASKED QUESTIONS

Does Ambetter require prior authorization for 92274?

Ambetter lists 92274 on Ambetter Health of Delaware CMS-0057-F prior authorization requirements for exchange plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does AmeriHealth Caritas require prior authorization for 92274?

AmeriHealth Caritas lists 92274 on AmeriHealth Caritas Louisiana Act 233 prior authorization service list for medicaid managed plans. Verify with the payer before scheduling.

Does CalViva Health require prior authorization for 92274?

CalViva Health lists 92274 on CalViva Health CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does Centene require prior authorization for 92274?

Centene lists 92274 on Sunshine Health Title XIX, Title XXI, Managed Medical Assistance CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does Community Health Plan of Imperial Valley require prior authorization for 92274?

Community Health Plan of Imperial Valley lists 92274 on Community Health Plan of Imperial Valley CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

What insurance policy changes affect CPT 92274?

There are 4 tracked policy changes affecting CPT 92274, including updates from Aetna Better Health of Virginia, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 92274?

Payers that have issued tracked updates for CPT 92274 include: Aetna Better Health of Virginia, Aetna.

How do I get notified when CPT 92274 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 92274. You will get an email when new policy changes reference this code: daily or weekly, your choice, on every plan.

Why do payers change policies for CPT 92274?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

See every payer rule for 92274

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 92274 in one place.

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