CPT 99174 is referenced in 5 tracked payer policy changes from Independence Blue Cross, Aetna, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 99174 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Independence Blue Cross reissued policy 07.13.12d confirming that instrument-based vision screening (CPT 99174, 99177) is considered part of the Evaluation and Management service and is NOT eligible for separate reimbursement, whether billed alone or with other services. Providers cannot bill members for this service.
Aetna Clinical Policy Bulletin 0689 considers ocular photo-screening medically necessary for screening pre-verbal children up to 5 years of age, and children or adolescents who are non-cooperative or non-verbal, such as those with intellectual disability, developmental delay, or severe behavioral disorders. CPT 99174 and 99177 are covered if selection criteria are met, while CPT 0469T is listed as not covered for the indications in the policy. Aetna considers retinal birefringence scanning for detecting eye misalignment or strabismus experimental, investigational, or unproven.
Aetna considers ocular photo-screening medically necessary for screening pre-verbal children up to 5 years of age, and for children or adolescents who are non-cooperative or non-verbal, such as those with intellectual disability, developmental delay, or severe behavioral disorders. Aetna considers retinal birefringence scanning for the detection of eye misalignment or strabismus experimental, investigational, or unproven because its effectiveness has not been established. CPT 99174 and 99177 are covered if the selection criteria are met, and CPT 0469T is not covered for the indications listed in the policy.
MDHHS updated the Michigan Medicaid Provider Manual in October 2021 with code changes for dates of service on and after July 1, 2021, including new HCPCS codes J0224, J1951, J7168, J9348, J9353 and Q5123 and new coverage of existing codes 99174, 99177 and Q4163. Retroactive coverage was added for codes M0244, M0246, M0247, M0248, Q0247, Q0244 and M0201, with start dates from May 6, 2021 to June 8, 2021. Codes C9074 and C9132 were discontinued effective June 30, 2021, and dental billing instructions for eligibility changes, incomplete procedures and orthodontic treatment were moved into the Billing & Reimbursement for Dental Providers chapter.
Independence Blue Cross reissued MA07.048a on 06/10/2026 to reaffirm its continuing position that instrument-based vision screening (CPT 99174, 99177) is considered an integral part of Evaluation and Management services and is NOT separately reimbursable. Providers may not bill members for this service. The policy applies to Medicare Advantage plans, including New Jersey MA lines of business effective 01/01/2024.
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