What insurance policy changes affect code H52.13?

There are 2 tracked policy changes affecting code H52.13, including updates from Indiana Medicaid (IHCP), Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code H52.13?

Payers that have issued tracked updates for code H52.13 include: Indiana Medicaid (IHCP), Aetna.

How do I get notified when code H52.13 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code H52.13. 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 H52.13?

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

H52.13 Insurance Policy Changes

ICD-10 H52.13 is officially defined as "Myopia, bilateral." code H52.13 is referenced in 2 tracked payer policy changes from Indiana Medicaid (IHCP) and Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code H52.13 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.

Indiana Medicaid (IHCP) · Effective Oct 28, 2026High impact
BT2026155: IHCP updates billing requirements for specific waiver services and specific vision services
IHCP implements two new billing restrictions effective Oct. 28, 2026: (1) Claims for waiver services T2033, S5151, and T2016 will be denied if billed with modifier HQ and POS code 12 (Home), and (2) V2755 (ultraviolet lens treatment) will be paid at $0 when billed with V2784 (polycarbonate lenses) unless V2755 has a diagnosis code outside the Refractive Error group. Billing teams must validate modifier/POS combinations for waiver services and diagnoses for vision claims before submission.
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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BT2026155: IHCP updates billing requirements for specific waiver services and specific vision services

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

What insurance policy changes affect code H52.13?

Which payers have updated policy for code H52.13?

How do I get notified when code H52.13 policy changes?

Why do payers change policies for code H52.13?