ICD-10 H31.101 is officially defined as "Choroidal degeneration, unspecified, right eye." code H31.101 is referenced in 5 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 H31.101 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Aetna has reinforced that laser photocoagulation of drusen (CPT 67220), including sub-threshold laser photocoagulation, for age-related macular degeneration prevention and treatment remains experimental, investigational, or unproven and is NOT covered. Claims for this procedure with related ICD-10 codes will be denied. This policy was reviewed/updated on 2025-12-02.
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 has reaffirmed that laser photocoagulation of drusen (CPT 67220), including sub-threshold laser photocoagulation, is considered experimental, investigational, or unproven for prevention and treatment of age-related macular degeneration and is NOT covered. Claims for this procedure with specified ICD-10 diagnoses will be denied. This policy was reviewed/updated on September 3, 2026.
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 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.
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