What insurance policy changes affect code H20.9?

There are 4 tracked policy changes affecting code H20.9, including updates from Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code H20.9?

Payers that have issued tracked updates for code H20.9 include: Aetna.

How do I get notified when code H20.9 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code H20.9. 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 H20.9?

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

H20.9 Insurance Policy Changes

ICD-10 H20.9 is officially defined as "Unspecified iridocyclitis." code H20.9 is referenced in 4 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 H20.9 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Aetna · Effective Jul 16, 2025Medium impact
Revakinagene Taroretcel-lwey (Encelto) (CPB 1079, reviewed 2026-10-05)
Aetna considers one intravitreal implant of Encelto (revakinagene taroretcel-lwey) per affected eye medically necessary for adults with idiopathic macular telangiectasia type 2 (MacTel) when the listed criteria are met, and considers all other indications experimental, investigational or unproven. The policy covers commercial medical plans, requires precertification in applicable plan designs, and requires that the drug be prescribed by or in consultation with an ophthalmologist. Members with intraretinal or subretinal neovascularization, anti-VEGF therapy within the past 3 months, glaucoma, uveitis, or current chemotherapy are listed as not eligible for the implant.
Aetna · Effective Jul 16, 2025Medium impact
Revakinagene Taroretcel-lwey (Encelto) (CPB 1079, reviewed 2026-07-17)
Aetna considers one intravitreal implant of revakinagene taroretcel-lwey (Encelto) medically necessary per affected eye for adults with idiopathic macular telangiectasia type 2 (MacTel) when all the listed criteria are met, and considers all other indications experimental, investigational or unproven. Eligibility requires fluorescein leakage in at least one eye with one of the listed features, a photoreceptor inner segment/outer segment break in the ellipsoid zone of 0.16 mm2 to 2.00 mm2 on spectral domain OCT, and best corrected visual acuity of 54 letters or better (20/80 or better) on the ETDRS chart. Exclusions include neovascular MacTel, prior intravitreal anti-VEGF therapy in the affected eye or in the non-affected eye within the past 3 months, glaucoma, uveitis, and inability to temporarily discontinue antithrombotic therapy. The implant must be prescribed by or in consultation with an ophthalmologist, and it requires precertification.
Aetna · Identified Oct 10, 2026Medium impact
Repository Corticotropin Injection (Acthar Gel and Purified Cortrophin Gel) (CPB 0762, reviewed 2026-10-08)
Aetna considers repository corticotropin injection (Acthar Gel only) medically necessary for infantile spasms in members less than 2 years of age, and considers all other indications experimental, investigational, unproven, or not medically necessary. Precertification of Acthar Gel or Purified Cortrophin Gel is required of all Aetna participating providers and members in applicable plan designs. Purified Cortrophin Gel is considered experimental, investigational, or unproven for infantile spasms because it is not FDA-approved, nor has a compendial use, for this indication, and use of Acthar Gel in combination with Purified Cortrophin Gel is considered experimental, investigational, or unproven.
Aetna · Identified Aug 12, 2026Medium impact
Certolizumab Pegol (Cimzia) (CPB 0761, reviewed 2026-07-01)
Aetna considers certolizumab pegol (Cimzia) medically necessary for commercial medical plans only for members who have a contraindication, intolerance or ineffective response to the listed lower cost targeted immune modulators, with waived trial requirements for members who are pregnant or breastfeeding. Precertification is required of all Aetna participating providers and members in applicable plan designs, and the medication must be prescribed by or in consultation with a specialist such as a rheumatologist, gastroenterologist, dermatologist or oncologist depending on the indication. Aetna considers Cimzia experimental, investigational or unproven for concomitant use with other biologics or targeted synthetic drugs for the same indication and for Behcet's disease, microscopic colitis, ocular inflammation/uveitis, sarcoidosis and severe asthma.

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Revakinagene Taroretcel-lwey (Encelto) (CPB 1079, reviewed 2026-10-05)

Revakinagene Taroretcel-lwey (Encelto) (CPB 1079, reviewed 2026-07-17)

Repository Corticotropin Injection (Acthar Gel and Purified Cortrophin Gel) (CPB 0762, reviewed 2026-10-08)

Certolizumab Pegol (Cimzia) (CPB 0761, reviewed 2026-07-01)

What insurance policy changes affect code H20.9?

Which payers have updated policy for code H20.9?

How do I get notified when code H20.9 policy changes?

Why do payers change policies for code H20.9?