ICD-10 H35.361 is officially defined as "Drusen (degenerative) of macula, right eye." code H35.361 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 H35.361 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 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.
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