What insurance policy changes affect code H47.011?

There are 3 tracked policy changes affecting code H47.011, including updates from Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code H47.011?

Payers that have issued tracked updates for code H47.011 include: Aetna.

How do I get notified when code H47.011 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code H47.011. 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 H47.011?

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

H47.011 Insurance Policy Changes

ICD-10 H47.011 is officially defined as "Ischemic optic neuropathy, right eye." code H47.011 is referenced in 3 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 H47.011 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Aetna · Identified Aug 18, 2026Medium impact
Obsolete and Unreliable Tests and Procedures (CPB 0438, reviewed 2026-07-16)
Aetna considers a list of tests experimental, investigational, or unproven because CMS has determined they are obsolete or unreliable, they have been replaced by more advanced procedures, or professional specialty societies do not recommend them, and the list includes the lupus erythematosus cell test, cardiointegram, and several serum and skin tests. Aetna also considers a set of obsolete procedures experimental, investigational, or unproven, including colectomy to treat epilepsy, mammary artery ligation for coronary artery disease, optic nerve decompression for non-arteritic anterior ischemic optic neuropathy, radiation therapy for acne, Ali Krogius procedure for patellofemoral instability, and visceral osteopathy. Each listed test or procedure has CPT, HCPCS, or ICD-10 codes that are not covered for the indications the policy names.
Aetna · Identified Aug 13, 2026Medium impact
Critical Flicker Fusion (CPB 0860, reviewed 2025-12-24)
Aetna considers critical flicker fusion experimental, investigational, or unproven for the indications the policy lists, which are not an all-inclusive list: an indicator of neurotoxic adverse events of drugs and visual fatigue, diagnosis of low-grade (minimal) hepatic encephalopathy, diagnosis of visual acuity, differential diagnosis of demyelinating optic neuritis and ischemic optic neuropathy, prediction of executive dysfunction, and prediction of visual outcomes in keratoprosthesis surgery and in surgery for cataract and/or macular disease. The policy states that the effectiveness of this approach for these indications has not been established. The policy lists no specific code for critical flicker fusion.
Aetna · Identified Aug 12, 2026Medium impact
Optic Nerve Decompression Surgery (CPB 0415, reviewed 2026-07-06)
Optic nerve decompression surgery is medically necessary for optic nerve sheath meningioma or parasellar meningioma, papilledema accompanying pseudotumor cerebri (idiopathic intracranial hypertension), progressive visual loss associated with craniofacial fibrous dysplasia, and secondary intracranial hypertension with cerebrovenous sinus thrombosis. It is considered experimental, investigational, or unproven for intermittent paroxysmal unilateral phosphenes, navigator-assisted trans-nasal endoscopic optic nerve decompression for traumatic optic neuropathy (TON), non-arteritic anterior ischemic optic neuropathy (NAION), traumatic and non-traumatic compressive optic neuropathy, and visual loss secondary to optic nerve drusen, because of insufficient evidence in the peer-reviewed literature. CPT 67570 is covered if the selection criteria are met.

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Obsolete and Unreliable Tests and Procedures (CPB 0438, reviewed 2026-07-16)

Critical Flicker Fusion (CPB 0860, reviewed 2025-12-24)

Optic Nerve Decompression Surgery (CPB 0415, reviewed 2026-07-06)

What insurance policy changes affect code H47.011?

Which payers have updated policy for code H47.011?

How do I get notified when code H47.011 policy changes?

Why do payers change policies for code H47.011?