CPT 92286, in plain terms, covers Clinician performs specular microscopy imaging of the anterior segment to analyze endothelial cells, includes interpretation and written report. CPT 92286 is referenced in 2 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 92286 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Official descriptor: CPT 92286 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.
Aetna's Endothelial Cell Photography policy (CPB 0538) clarifies medical necessity criteria for CPT codes 92286 and 92287 when used to assess corneal endothelial cell counts prior to ocular surgery. The policy covers seven specific clinical indications (pre-fitting extended wear contacts post-surgery, secondary IOL implantation, high-risk corneal procedures, previous intraocular surgery requiring cataract repair, corneal edema, endothelial dystrophy, and posterior polymorphous dystrophy) and designates the procedure as experimental/investigational for all other uses.
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