H44.2E9 Insurance Policy Changes

ICD-10 H44.2E9 is officially defined as "Degenerative myopia with other maculopathy, unspecified eye." code H44.2E9 is referenced in 3 tracked payer policy changes from Independence Blue Cross and Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code H44.2E9 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.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code H44.2E9?

There are 3 tracked policy changes affecting code H44.2E9, including updates from Independence Blue Cross, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code H44.2E9?

Payers that have issued tracked updates for code H44.2E9 include: Independence Blue Cross, Aetna.

How do I get notified when code H44.2E9 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code H44.2E9. 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 H44.2E9?

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)

What insurance policy changes affect code H44.2E9?

Which payers have updated policy for code H44.2E9?

How do I get notified when code H44.2E9 policy changes?

Why do payers change policies for code H44.2E9?