What insurance policy changes affect code S04.011A?

There are 3 tracked policy changes affecting code S04.011A, including updates from Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code S04.011A?

Payers that have issued tracked updates for code S04.011A include: Aetna.

How do I get notified when code S04.011A policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code S04.011A. 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 S04.011A?

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

S04.011A Insurance Policy Changes

ICD-10 S04.011A is officially defined as "Injury of optic nerve, right eye, initial encounter." code S04.011A 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 S04.011A is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Aetna · Identified Aug 15, 2026Medium impact
Carbogen Inhalation Therapy (CPB 0428, reviewed 2026-07-09)
Carbogen inhalation therapy (5% carbon dioxide and 95% oxygen) is considered experimental, investigational, or unproven for bladder cancer, central retinal artery occlusion, cervical cancer, fracture healing, head and neck cancers, optic nerve damage or degeneration, prostate cancer, retinal artery occlusion, seizures, stroke, and sudden hearing loss. The policy lists no specific CPT or HCPCS code for carbogen inhalation therapy, and the ICD-10 diagnosis codes for these indications are listed as not covered for carbogen inhalation therapy. The policy was last reviewed 07/09/2026.
Aetna · Identified Aug 14, 2026Medium impact
Magnetic Resonance Neurography (CPB 0387, reviewed 2025-08-01)
Aetna considers magnetic resonance neurography experimental, investigational, or unproven because the medical literature on its clinical use remains in early stages of development. The policy lists ICD-10 codes for nerve, nerve root and plexus disorders (G50.0 through G59) and for injury to nerves and spinal cord (S04 through S94 ranges) as not covered for the indications listed. There are no specific CPT or HCPCS codes for magnetic resonance neurography.
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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Carbogen Inhalation Therapy (CPB 0428, reviewed 2026-07-09)

Magnetic Resonance Neurography (CPB 0387, reviewed 2025-08-01)

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

What insurance policy changes affect code S04.011A?

Which payers have updated policy for code S04.011A?

How do I get notified when code S04.011A policy changes?

Why do payers change policies for code S04.011A?