What insurance policy changes affect code H43.399?

There are 4 tracked policy changes affecting code H43.399, including updates from Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code H43.399?

Payers that have issued tracked updates for code H43.399 include: Aetna.

How do I get notified when code H43.399 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code H43.399. 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 H43.399?

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

H43.399 Insurance Policy Changes

ICD-10 H43.399 is officially defined as "Other vitreous opacities, unspecified eye." code H43.399 is referenced in 4 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 H43.399 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

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 19, 2026Medium impact
YAG Laser in Ophthalmology and Other Selected Indications (CPB 0354, reviewed 2026-05-21)
Aetna considers Nd:YAG laser capsulotomy medically necessary after cataract extraction in members with visually significant clouding of the posterior capsule, and considers Nd:YAG laser peripheral iridotomy medically necessary for acute primary angle closure, primary angle-closure glaucoma, plateau iris syndrome, aqueous misdirection, and before intraocular lens insertion into the anterior chamber to avoid post-operative iris bombe or pupil block. Capsulotomy performed within 6 months of cataract surgery is subject to medical necessity review, and it is considered experimental, investigational, or unproven if none of the stated criteria is met. Nd:YAG laser vitreolysis for vitreous floaters, posterior hyaloidotomy for pre-macular hemorrhage, goniopuncture for failed trabeculectomy, and peripheral iridotomy to prevent pigment dispersion glaucoma are considered experimental, investigational, or unproven, as are many non-ophthalmological uses such as basal cell carcinoma, benign prostatic hyperplasia, onychomycosis and snoring.
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.

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

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

YAG Laser in Ophthalmology and Other Selected Indications (CPB 0354, reviewed 2026-05-21)

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

What insurance policy changes affect code H43.399?

Which payers have updated policy for code H43.399?

How do I get notified when code H43.399 policy changes?

Why do payers change policies for code H43.399?