ICD-10 H47.321 is officially defined as "Drusen of optic disc, right eye." code H47.321 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 H47.321 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Aetna has reinforced that laser photocoagulation of drusen (CPT 67220), including sub-threshold laser photocoagulation, for age-related macular degeneration prevention and treatment remains experimental, investigational, or unproven and is NOT covered. Claims for this procedure with related ICD-10 codes will be denied. This policy was reviewed/updated on 2025-12-02.
Aetna has reaffirmed that laser photocoagulation of drusen (CPT 67220), including sub-threshold laser photocoagulation, is considered experimental, investigational, or unproven for prevention and treatment of age-related macular degeneration and is NOT covered. Claims for this procedure with specified ICD-10 diagnoses will be denied. This policy was reviewed/updated on September 3, 2026.
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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