E08.311 Insurance Policy Changes

ICD-10 E08.311 is officially defined as "Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy with macular edema." code E08.311 is referenced in 7 tracked payer policy changes from Aetna and Blue Cross & Blue Shield of Mississippi. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code E08.311 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Aetna · Identified Nov 1, 2026Medium impact
Fluocinolone Acetonide Intra-vitreal Implant (Retisert, Yutiq and Iluvien) (CPB 0719, reviewed 2026-10-26)
Aetna's Clinical Policy Bulletin 0719 on fluocinolone acetonide intravitreal implants (Retisert, Yutiq and Iluvien) was last reviewed 10/26/2026. Aetna considers Retisert and Yutiq medically necessary for chronic non-infectious uveitis affecting the posterior segment in persons who do not respond to or are intolerant to conventional treatment, and considers Iluvien medically necessary for diabetic macular edema in persons previously treated with a course of corticosteroids who did not have a clinically significant rise in intraocular pressure. Retisert and Yutiq are contraindicated and considered not medically necessary for members with active ocular or periocular infections, and Iluvien is not considered medically necessary for members with active ocular or periocular infections or glaucoma with a cup to disc ratio greater than 0.8.
Aetna · Identified Oct 23, 2026Medium impact
Artificial Retina and Artificial Iris (CPB 0713, reviewed 2026-10-15)
Aetna considers artificial retina devices, such as the Argus II, and artificial iris devices, such as the CustomFlex Artificial Iris, experimental, investigational, or unproven because their effectiveness has not been established. The CPT, HCPCS and ICD-10 codes listed in the policy are not covered for the indications listed in the policy, which include anterior segment reconstruction, aniridia, post-operative or traumatic aphakia and other iris defects. The policy states that there is insufficient evidence that artificial retina devices result in improved useful vision, and that the available evidence on artificial iris use for aniridia is weak.
Aetna · Identified Oct 8, 2026Medium impact
Dexamethasone Ophthalmic Implant (Ozurdex) and Insert (Dextenza) (CPB 0795, reviewed 2026-10-05)
Aetna covers Ozurdex (dexamethasone intravitreal implant) for macular edema from branch or central retinal vein occlusion, non-infectious uveitis affecting the posterior segment of the eye, and diabetic macular edema. Aetna considers Ozurdex not medically necessary with ocular or periocular infections, advanced glaucoma, aphakic eyes with rupture of the posterior lens capsule, or a non-intact posterior lens capsule, and it considers many other uses experimental and investigational because evidence is insufficient. Dextenza (dexamethasone ophthalmic insert) is covered for ocular inflammation and pain following ophthalmic surgery and for ocular itching associated with allergic conjunctivitis after failure of listed topical treatments, and it is not medically necessary with active ocular infection.
Aetna · Identified Aug 17, 2026Medium impact
ADAMTS13 Assay for Thrombotic Thrombocytopenic Purpura (TTP) (CPB 0780, reviewed 2026-04-27)
Aetna considers the ADAMTS13 assay medically necessary for assessing prognosis in persons with thrombotic thrombocytopenic purpura (TTP), and for distinguishing hematopoietic stem cell transplant-associated thrombotic microangiopathy (HSCT-TMA, also called transplant-associated TMA) from TTP in persons with overlapping features when the test will be used to inform treatment. Aetna considers the assay experimental, investigational, or unproven for the uses it lists because of insufficient evidence, including sepsis-associated thrombotic microangiopathy, hemolytic uremic syndrome, acute myelogenous leukemia, colorectal cancer survival, COVID-19, cerebral infarction, and ADAMTS13 mutation testing for non-cirrhotic portal hypertension.
Aetna · Identified Aug 15, 2026Medium impact
Extended Ophthalmoscopy (CPB 0767, reviewed 2025-12-02)
Aetna considers extended ophthalmoscopy with a detailed retinal drawing (CPT 92201 and 92202) medically necessary for evaluation of the posterior portion of the eye after routine ophthalmoscopy for listed indications such as retinal detachment, diabetic retinopathy, macular degeneration, uncontrolled glaucoma or glaucoma suspect, and high axial length myopia of -6.00 diopters or less. It is not medically necessary when routine ophthalmoscopy showed normal clinical findings, and a repeat examination is medically necessary only when there is a change in signs, symptoms or condition for an indication that may progress. The service must add information not available from standard evaluation services or information that will demonstrably affect the treatment plan, and it is considered experimental, investigational or unproven for conditions such as optic neuritis, sickle cell disease and screening for retinoblastoma.
Aetna · Identified Aug 12, 2026Medium impact
Artificial Retina and Artificial Iris (CPB 0713, reviewed 2025-11-25)
Aetna considers artificial retina devices, such as the Argus II, experimental, investigational, or unproven because the effectiveness of these approaches has not been established. Aetna also considers artificial iris devices, such as the CustomFlex Artificial Iris, experimental, investigational, or unproven for anterior segment reconstruction and for the treatment of aniridia, post-operative or traumatic aphakia, and other iris defects. The listed CPT, HCPCS and ICD-10 codes are not covered for the indications listed in the policy.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Retinal Telescreening for Diabetic Retinopathy
Retinal telescreening with digital imaging and manual grading of images may be considered medically necessary as a screening technique for the detection of diabetic retinopathy. Digital retinal imaging with image interpretation by FDA-approved artificial intelligence software, such as IDX-DR or EyeArt, may be considered medically necessary for screening for diabetic retinopathy. Retinal telescreening is considered investigational for all other indications, including the monitoring and management of disease in individuals diagnosed with diabetic retinopathy.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code E08.311?

There are 7 tracked policy changes affecting code E08.311, including updates from Aetna, Blue Cross & Blue Shield of Mississippi. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code E08.311?

Payers that have issued tracked updates for code E08.311 include: Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when code E08.311 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code E08.311. 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 code E08.311?

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.

All billing codes J3590 C9399 J3490 99215 99213 99202

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Fluocinolone Acetonide Intra-vitreal Implant (Retisert, Yutiq and Iluvien) (CPB 0719, reviewed 2026-10-26)

Artificial Retina and Artificial Iris (CPB 0713, reviewed 2026-10-15)

Dexamethasone Ophthalmic Implant (Ozurdex) and Insert (Dextenza) (CPB 0795, reviewed 2026-10-05)

ADAMTS13 Assay for Thrombotic Thrombocytopenic Purpura (TTP) (CPB 0780, reviewed 2026-04-27)

Extended Ophthalmoscopy (CPB 0767, reviewed 2025-12-02)

Artificial Retina and Artificial Iris (CPB 0713, reviewed 2025-11-25)

Retinal Telescreening for Diabetic Retinopathy

What insurance policy changes affect code E08.311?

Which payers have updated policy for code E08.311?

How do I get notified when code E08.311 policy changes?

Why do payers change policies for code E08.311?