What insurance policy changes affect code H05.89?

There are 2 tracked policy changes affecting code H05.89, including updates from Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code H05.89?

Payers that have issued tracked updates for code H05.89 include: Aetna.

How do I get notified when code H05.89 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code H05.89. 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 H05.89?

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.

PAYER POLICY CHANGES

H05.89 Insurance Policy Changes

ICD-10 H05.89 is officially defined as "Other disorders of orbit." code H05.89 is referenced in 2 tracked payer policy changes from Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code H05.89 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Only a small number of policies match this filter. Check back as coverage expands.

Aetna · Identified Aug 16, 2026Medium impact
Eyelid Surgery (CPB 0084, reviewed 2026-03-03)
Upper lid blepharoplasty is medically necessary to correct prosthesis difficulties in an anophthalmia socket, to relieve painful blepharospasm, to treat peri-orbital sequelae of thyroid disease and nerve palsy, or to remove excess upper eyelid tissue causing functional visual impairment when photographs and visual field testing from the past 12 months meet the stated criteria. Upper lid ptosis repair and brow ptosis repair for functional visual impairment are medically necessary when their listed criteria are met, and ectropion and entropion repair are medically necessary to repair defects predisposing to corneal or conjunctival injury when selection criteria are met. Surgical correction of congenital ptosis is medically necessary to allow proper visual development in infants and children when the ptosis interferes with the field of vision and the child has abnormal head posture, amblyopia or strabismus, and congenital ptosis surgery is considered cosmetic when performed for mild ptosis that is only of cosmetic concern.
Aetna · Identified Aug 15, 2026Medium impact
Graves' Ophthalmopathy Treatments (CPB 0419, reviewed 2026-04-23)
Aetna's Clinical Policy Bulletin 0419 covers treatments for Graves' ophthalmopathy (thyroid eye disease) under commercial medical plans. Aetna considers teprotumumab-trbw (Tepezza) medically necessary for adults 18 or older with moderate-to-severe active or inactive disease, for one course of 8 infusions, and considers repeat courses and all other indications experimental, investigational, or unproven. Orbital decompression, eye muscle surgery, eyelid surgery and orbital radiotherapy are medically necessary for severe disease only when conservative measures and medications have not been successful.

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Eyelid Surgery (CPB 0084, reviewed 2026-03-03)

Graves' Ophthalmopathy Treatments (CPB 0419, reviewed 2026-04-23)

What insurance policy changes affect code H05.89?

Which payers have updated policy for code H05.89?

How do I get notified when code H05.89 policy changes?

Why do payers change policies for code H05.89?