H35.711 Insurance Policy Changes

ICD-10 H35.711 is officially defined as "Central serous chorioretinopathy, right eye." code H35.711 is referenced in 5 tracked payer policy changes from Independence Blue Cross, Aetna, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code H35.711 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Independence Blue Cross · Effective Feb 2, 2026Medium impact
MA07.003f, Photodynamic Therapy Using Verteporfin (Visudyne®)
Independence Blue Cross reissued MA07.003f on 02/02/2026 with no substantive changes to photodynamic therapy coverage criteria, but removed 15 ICD-10 diagnosis codes that are no longer covered under this policy. The policy aligns with CMS National Coverage Determinations (NCDs) for verteporfin PDT treatment of choroidal neovascularization associated with AMD, presumed ocular histoplasmosis, and pathologic myopia. Billing teams must remove the deleted ICD-10 codes from claim submission logic to prevent denials.
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 Aug 18, 2026Medium impact
Transpupillary Thermal Therapy (CPB 0490, reviewed 2026-08-03)
Aetna considers transpupillary thermotherapy medically necessary for retinoblastoma involving less than 50% of the retina, without associated vitreal or sub-retinal seeds at the time of thermotherapy, and for small (2 to 3 mm) choroidal melanomas located posterior in the globe. Aetna considers transpupillary thermotherapy experimental, investigational, or unproven for all other indications, including central serous chorioretinopathy, choroidal metastases, choroidal neovascularization associated with age-related macular degeneration, polypoidal choroidal vasculopathy, and retinopathy of prematurity.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Photodynamic Therapy for Choroidal Neovascularization
BCBSMS considers verteporfin photodynamic therapy as monotherapy medically necessary for choroidal neovascularization associated with age-related macular degeneration, pathologic myopia, presumed ocular histoplasmosis, chronic central serous chorioretinopathy, or choroidal hemangioma. Verteporfin photodynamic therapy as monotherapy for other ophthalmologic disorders is considered investigational. Verteporfin photodynamic therapy combined with ranibizumab, bevacizumab, aflibercept, brolucizumab-dbll or faricimab-svoa is also considered investigational.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code H35.711?

There are 5 tracked policy changes affecting code H35.711, including updates from Independence Blue Cross, Aetna, Blue Cross & Blue Shield of Mississippi. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code H35.711?

Payers that have issued tracked updates for code H35.711 include: Independence Blue Cross, Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when code H35.711 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code H35.711. 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 H35.711?

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.

All billing codes J3590 C9399 J3490 99215 99213 99202

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MA07.003f, Photodynamic Therapy Using Verteporfin (Visudyne®)

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

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

Transpupillary Thermal Therapy (CPB 0490, reviewed 2026-08-03)

Photodynamic Therapy for Choroidal Neovascularization

What insurance policy changes affect code H35.711?

Which payers have updated policy for code H35.711?

How do I get notified when code H35.711 policy changes?

Why do payers change policies for code H35.711?