H18.239 Insurance Policy Changes

ICD-10 H18.239 is officially defined as "Secondary corneal edema, unspecified eye." code H18.239 is referenced in 4 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 H18.239 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Aetna · Identified Oct 1, 2026Medium impact
Endothelial Cell Photography (CPB 0538, reviewed 2026-08-26)
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.
Aetna · Identified Aug 15, 2026Medium impact
Corneal Pachymetry (CPB 0681, reviewed 2025-10-15)
Aetna considers ultrasound corneal pachymetry (CPT 76514) medically necessary for listed indications, including keratoconus, Fuchs' endothelial dystrophy, corneal edema, bullous keratopathy, corneal transplant and corneal refractive surgery evaluations, narrow angles, and glaucoma or glaucoma suspects, with the glaucoma indication covered once per lifetime. Repeat pachymetry for corneal diseases and injuries is not medically necessary if performed more frequently than once every 6 months. Screening for glaucoma without signs or symptoms, diagnosis of Marfan syndrome, pterygium management and monitoring on hydroxychloroquine are listed as experimental, investigational or unproven.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Endothelial Keratoplasty
Blue Cross Blue Shield Association policy 9.03.22, now listed as BCBSMS policy L.9.03.412, states that endothelial keratoplasty (Descemet stripping endothelial keratoplasty, Descemet stripping automated endothelial keratoplasty, Descemet membrane endothelial keratoplasty, or Descemet membrane automated endothelial keratoplasty) may be considered medically necessary for endothelial dysfunction, including ruptures in Descemet membrane, endothelial dystrophy, aphakic and pseudophakic bullous keratopathy, iridocorneal endothelial syndrome, corneal edema attributed to endothelial failure, and failure or rejection of a previous corneal transplant. Femtosecond laser-assisted endothelial keratoplasty and femtosecond and excimer laser-assisted endothelial keratoplasty are considered investigational, and endothelial keratoplasty is considered investigational when endothelial dysfunction is not the primary cause of decreased corneal clarity. The most recent policy update, dated 03/11/2026, removed ICD-9 diagnosis codes from the policy.
Aetna · Identified Nov 3, 2026Low impact
Corneal Pachymetry (CPB 0681, reviewed 2026-10-26)
This is Aetna's clinical policy bulletin on ultrasound corneal pachymetry (corneal thickness measurement), CPB 0681, last reviewed October 26, 2026. It lists the indications where the test is considered medically necessary, the uses Aetna considers experimental, and a limit of one repeat test every six months for corneal diseases and injuries. The text does not describe a new rule with a stated effective date, so treat it as current policy language and confirm with Aetna before relying on it.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code H18.239?

There are 4 tracked policy changes affecting code H18.239, 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 H18.239?

Payers that have issued tracked updates for code H18.239 include: Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when code H18.239 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code H18.239. 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 H18.239?

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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Endothelial Cell Photography (CPB 0538, reviewed 2026-08-26)

Corneal Pachymetry (CPB 0681, reviewed 2025-10-15)

Endothelial Keratoplasty

Corneal Pachymetry (CPB 0681, reviewed 2026-10-26)

What insurance policy changes affect code H18.239?

Which payers have updated policy for code H18.239?

How do I get notified when code H18.239 policy changes?

Why do payers change policies for code H18.239?