What insurance policy changes affect code H35.52?

There are 3 tracked policy changes affecting code H35.52, including updates from Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code H35.52?

Payers that have issued tracked updates for code H35.52 include: Aetna.

How do I get notified when code H35.52 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code H35.52. 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 H35.52?

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

H35.52 Insurance Policy Changes

ICD-10 H35.52 is officially defined as "Pigmentary retinal dystrophy." code H35.52 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 H35.52 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Aetna · Identified Oct 4, 2026Medium impact
Hematopoietic Cell Transplantation for Autoimmune Diseases and Miscellaneous Indications (CPB 0606, reviewed 2026-09-18)
Aetna considers autologous hematopoietic cell transplantation medically necessary for adults 18 to 69 years old with rapidly progressive scleroderma (systemic sclerosis) at risk of organ failure. This applies when active interstitial lung disease is present with a forced vital capacity or diffusing capacity of the lung for carbon monoxide below 70% of predicted, or when previous scleroderma-related renal disease is present, and the member meets the transplanting institution's selection criteria or, if there are none, has none of the listed exclusion criteria. Aetna considers autologous or allogeneic hematopoietic cell transplantation experimental, investigational, or unproven for conditions including multiple sclerosis, rheumatoid arthritis, systemic lupus erythematosus, Crohn's disease, ulcerative colitis, myasthenia gravis, type I diabetes mellitus, age-related macular degeneration, amyotrophic lateral sclerosis, polycythemia vera, and thrombotic thrombocytopenic purpura.
Aetna · Identified Aug 17, 2026Medium impact
Hematopoietic Cell Transplantation for Autoimmune Diseases and Miscellaneous Indications (CPB 0606, reviewed 2025-09-10)
Aetna's Clinical Policy Bulletin 0606 covers hematopoietic cell transplantation for autoimmune diseases and other listed conditions. Aetna considers autologous transplant medically necessary for adults aged 18 to 69 with rapidly progressive scleroderma (systemic sclerosis) at risk of organ failure when either active interstitial lung disease with an FVC or DLCO below 70% of predicted is present, or previous scleroderma-related renal disease is present, and the member meets the transplanting institution's selection criteria or, where none exist, has none of the listed exclusion criteria. Aetna considers autologous or allogeneic transplant experimental, investigational or unproven for many autoimmune diseases, including multiple sclerosis, rheumatoid arthritis, systemic lupus erythematosus, Crohn's disease, ulcerative colitis, type 1 diabetes and myasthenia gravis, and for miscellaneous conditions such as age-related macular degeneration, amyotrophic lateral sclerosis, polycythemia vera and thrombotic thrombocytopenic purpura.
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.

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Hematopoietic Cell Transplantation for Autoimmune Diseases and Miscellaneous Indications (CPB 0606, reviewed 2026-09-18)

Hematopoietic Cell Transplantation for Autoimmune Diseases and Miscellaneous Indications (CPB 0606, reviewed 2025-09-10)

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

What insurance policy changes affect code H35.52?

Which payers have updated policy for code H35.52?

How do I get notified when code H35.52 policy changes?

Why do payers change policies for code H35.52?