H40.1194 Insurance Policy Changes

ICD-10 H40.1194 is officially defined as "Primary open-angle glaucoma, unspecified eye, indeterminate stage." code H40.1194 is referenced in 3 tracked payer policy changes from Aetna and Blue Cross & Blue Shield of Mississippi. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code H40.1194 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
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.
Aetna · Identified Aug 17, 2026Medium impact
Glaucoma Testing (CPB 0622, reviewed 2025-09-25)
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 artificial intelligence-based glaucoma detection, continuous intraocular pressure monitoring, glaucoma genetic testing, home-based perimetry, home tonometry such as the Icare Home Tonometer, corneal hysteresis measurement, ocular blood flow analyzers, provocative tests, rapid campimetry, the RETeval device, and visual evoked potentials experimental, investigational, or unproven. CPT codes 76514, 92020, 92081, 92082, 92083, 92100, 92133 and 92134 are covered if selection criteria are met, and CPT codes 0198T, 0329T, 0464T, 0509T, 92145, 92273, 92274, 99453, 99454 and 99457 are not covered for the indications listed.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Viscocanalostomy and Canaloplasty
Canaloplasty may be considered medically necessary as a method to reduce intraocular pressure in individuals with chronic primary open-angle glaucoma when medical therapy has failed to adequately control intraocular pressure and the individual is not a candidate for another intraocular pressure-lowering procedure, such as trabeculectomy or a glaucoma drainage implant, due to a high risk for complications. Canaloplasty is considered investigational under all other conditions, including angle-closure glaucoma. Viscocanalostomy is considered investigational.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code H40.1194?

There are 3 tracked policy changes affecting code H40.1194, including updates from 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 H40.1194?

Payers that have issued tracked updates for code H40.1194 include: Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when code H40.1194 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code H40.1194. 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 H40.1194?

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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Glaucoma Testing (CPB 0622, reviewed 2026-09-23)

Glaucoma Testing (CPB 0622, reviewed 2025-09-25)

Viscocanalostomy and Canaloplasty

What insurance policy changes affect code H40.1194?

Which payers have updated policy for code H40.1194?

How do I get notified when code H40.1194 policy changes?

Why do payers change policies for code H40.1194?