Glaucoma Testing (CPB 0622, reviewed 2026-09-23)
Aetna considers computerized visual field examination, gonioscopy, measurement of the optic nerve head and retinal nerve fiber layer, pachymetry and tonometry medically necessary for evaluation of primary open-angle glaucoma. Aetna considers the following experimental, investigational or unproven: artificial intelligence-based detection of glaucoma, continuous monitoring of intra-ocular pressure, genotyping and genetic testing for glaucoma, home-based perimetry, home tonometry such as the Icare Home Tonometer, measurement of corneal hysteresis, ocular blood flow analyzers and tonometers, provocative tests, rapid campimetry, the RETeval portable electroretinogram device, and visual evoked potential testing. The listed CPT codes are covered when selection criteria are met, and ICD-10 codes H40.1110 through H40.1194 for primary open-angle glaucoma are covered when selection criteria are met.