What insurance policy changes affect code H43.9?

There are 2 tracked policy changes affecting code H43.9, including updates from Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code H43.9?

Payers that have issued tracked updates for code H43.9 include: Aetna.

How do I get notified when code H43.9 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code H43.9. 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 H43.9?

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

H43.9 Insurance Policy Changes

ICD-10 H43.9 is officially defined as "Unspecified disorder of vitreous body." code H43.9 is referenced in 2 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 H43.9 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Only a small number of policies match this filter. Check back as coverage expands.

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.
Aetna · Identified Aug 15, 2026Medium impact
Extended Ophthalmoscopy (CPB 0767, reviewed 2025-12-02)
Aetna considers extended ophthalmoscopy with a detailed retinal drawing (CPT 92201 and 92202) medically necessary for evaluation of the posterior portion of the eye after routine ophthalmoscopy for listed indications such as retinal detachment, diabetic retinopathy, macular degeneration, uncontrolled glaucoma or glaucoma suspect, and high axial length myopia of -6.00 diopters or less. It is not medically necessary when routine ophthalmoscopy showed normal clinical findings, and a repeat examination is medically necessary only when there is a change in signs, symptoms or condition for an indication that may progress. The service must add information not available from standard evaluation services or information that will demonstrably affect the treatment plan, and it is considered experimental, investigational or unproven for conditions such as optic neuritis, sickle cell disease and screening for retinoblastoma.

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

Extended Ophthalmoscopy (CPB 0767, reviewed 2025-12-02)

What insurance policy changes affect code H43.9?

Which payers have updated policy for code H43.9?

How do I get notified when code H43.9 policy changes?

Why do payers change policies for code H43.9?