What insurance policy changes affect code H35.50?

There are 3 tracked policy changes affecting code H35.50, including updates from Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code H35.50?

Payers that have issued tracked updates for code H35.50 include: Aetna.

How do I get notified when code H35.50 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code H35.50. 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 H35.50?

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

H35.50 Insurance Policy Changes

ICD-10 H35.50 is officially defined as "Unspecified hereditary retinal dystrophy." code H35.50 is referenced in 3 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 H35.50 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Aetna · Identified Aug 19, 2026Medium impact
Voretigene Neparvovec-rzyl (Luxturna) (CPB 0927, reviewed 2026-04-20)
Aetna covers voretigene neparvovec-rzyl (Luxturna) for commercial medical plans, and precertification is required of all Aetna participating providers and members in applicable plan designs. Aetna considers one-time administration per eye medically necessary for biallelic RPE65 mutation-associated retinal dystrophy when the member meets the listed criteria. Repeat administration in the same eye is considered experimental, investigational, or unproven, and the medication must be prescribed by or in consultation with an ophthalmologist.
Aetna · Identified Aug 18, 2026Medium impact
Vitrectomy (CPB 0393, reviewed 2026-07-08)
This Aetna clinical policy bulletin addresses vitrectomy. Aetna considers vitrectomy medically necessary for these conditions: epiretinal membrane with progression or worsening of vision; macular hole repair; proliferative retinopathy; rapidly progressing infectious endophthalmitis; removal of silicone oil used in the treatment of retinal detachment; retinal detachments secondary to vitreous strands; RPE65 mutation-associated retinal dystrophy; traumatic penetrating ocular injury; vitreous loss incident to cataract surgery; vitreoretinal lymphoma; vitreous membranes, strands and other opacities due to vitreous hemorrhage or other causes; and vitreous retraction. Aetna also considers a vitrectomy face support device (post-vitrectomy face-down support system) medically necessary for members who have had vitrectomy surgery and must maintain a face-down position in the post-operative period. Aetna considers these experimental, investigational, or unproven: autologous retinal transplant for macular holes; combined pars plana vitrectomy (PPV) with phacoemulsification for retinal detachment; combined PPV with scleral buckling for retinal detachment; monitoring of intra-ocular pressure during vitrectomy surgery; prophylactic PPV for acute retinal necrosis; and PPV for the treatment of asymptomatic vitreous floaters. Codes 66850, 66852, 66982, 66984, 66987, 66988, 66989, 66991 and 67107 are listed as not covered for the indications in this policy.
Aetna · Identified Aug 14, 2026Medium impact
Quantitative Pupillometry/Pupillography (CPB 0879, reviewed 2025-12-29)
Aetna considers quantitative pupillometry and pupillography experimental, investigational, or unproven for all indications, including the following: intracranial pressure monitoring, pain assessment, early concussion assessment, Parkinson disease, Alzheimer's disease, heart failure, depression, prediction of outcome after cardiac arrest, and glaucoma, because its effectiveness has not been established. Chromatic pupillography is considered experimental, investigational, or unproven for detecting glaucoma, Leber congenital amaurosis, optic nerve diseases, and retinitis pigmentosa, and for evaluating Gaucher disease and hemianopia. CPT 95919 (quantitative pupillometry with physician or other qualified health care professional interpretation and report) is listed as not covered for the indications in this policy.

Watch H35.50

Get one email when a payer policy names H35.50, a payer adds or drops it from a prior auth list, or Medicare changes its NCCI pairs, unit limit, payment or coverage articles.

Get alerts for changes like this

Save a search and get email alerts when a new policy change matches your filters: daily or weekly, your choice, on every plan.

Create a free alert How Policy Monitoring works

Voretigene Neparvovec-rzyl (Luxturna) (CPB 0927, reviewed 2026-04-20)

Vitrectomy (CPB 0393, reviewed 2026-07-08)

Quantitative Pupillometry/Pupillography (CPB 0879, reviewed 2025-12-29)

What insurance policy changes affect code H35.50?

Which payers have updated policy for code H35.50?

How do I get notified when code H35.50 policy changes?

Why do payers change policies for code H35.50?