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AetnaAll Plans · Coverage · Radiology · Ophthalmology, Neurology, RadiologyMedium impact

Optic Nerve and Retinal Imaging Methods (CPB 0344, reviewed 2026-05-26)

Effective date
Not stated in the notice
Identified
Aug 12, 2026

Summary

Aetna's Clinical Policy Bulletin 0344 covers optic nerve and retinal imaging. Aetna considers these imaging methods medically necessary for documenting the appearance of the optic nerve head and retina in conditions including age-related macular degeneration, diabetic retinopathy, glaucoma and glaucoma suspects, macular edema, macular hole, and screening and monitoring for toxicity from chloroquine, ethambutol, hydroxychloroquine, siponimod, vigabatrin and other listed drugs. Aetna considers OCT angiography (OCTA) medically necessary as an alternative to intravenous fluorescein angiography for listed retinal conditions, but considers performing both OCTA and fluorescein angiography, or both OCT and OCTA, for the same indication not medically necessary. Aetna considers these imaging methods experimental, investigational or unproven for uses such as cataracts, dry eye disease, routine screening of asymptomatic persons for glaucoma, and OCTA for diagnosing and monitoring glaucoma.

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What to do

Action · 7 steps
01Billing team: Bill optic nerve and retinal imaging for the diagnoses listed in the policy.
02CPT 92133, 92134 and 92137 are covered when the policy's selection criteria are met, so claims need documentation that those criteria are met.
03Do not bill both OCTA and fluorescein angiography, or both OCT and OCTA, for the same indication, because Aetna considers that not medically necessary.
04Do not bill optic nerve imaging for glaucoma more frequently than once per year, because Aetna considers that not medically necessary.
05CPT 0469T and the remote OCT codes 0604T, 0605T and 0606T are not covered for the indications listed in the policy.
06Ultrasonographic assessment of optic nerve sheath diameter is not covered for the indications listed in the policy.
07Before starting chloroquine, hydroxychloroquine or vigabatrin therapy, a baseline study of optic nerve and retinal imaging is medically necessary, and annual screening should begin after 5 years of use or sooner if there are unusual risk factors.

Codes mentioned

921339213492137

Original notice

Optic Nerve and Retinal Imaging Methods (CPB 0344, reviewed 2026-05-26)
aetna.com · Always check the source before changing claims.
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Related changes

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Related policy hubs

Aetna policiesOphthalmologyNeurologyRadiologyCode 92133Code 92134Code 92137

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