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AetnaCommercial · Coverage · Medical Policy · Ophthalmology, OptometryMedium impact

Orthoptic Vision Therapy (CPB 0489, reviewed 2025-07-28)

Effective date
Not stated in the notice
Identified
Aug 13, 2026

Summary

Aetna considers up to 12 orthoptic vision therapy visits or sessions medically necessary for convergence insufficiency under plans without a vision therapy exclusion, and requests above 12 visits for this indication are subject to medical review. Members should be transitioned to a home program of exercises for convergence insufficiency, such as pencil push-ups. Eye tracking digital systems such as the CureSight System are considered medically necessary for amblyopia in a child who has tried and failed 6 months of conservative treatment, while online digital amblyopia training software, orthoptic vision therapy for other indications, RightEye Sensorimotor, and visual information processing evaluations are considered experimental, investigational, or unproven.

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What to do

Action · 5 steps
01Check the member's benefit plan description before billing orthoptic vision therapy, since some Aetna plans specifically exclude vision therapy (orthoptic training) for any diagnosis and most Aetna plans exclude services related to learning disabilities or developmental delays.
02For convergence insufficiency under plans without that exclusion, requests for more than 12 orthoptic vision therapy visits or sessions are subject to medical review, and members should be transitioned to a home program of exercises such as pencil push-ups.
03For amblyopia, eye tracking digital system treatment (CPT 0704T, 0705T, 0706T) is considered medically necessary when the child has tried and failed 6 months of full-time glasses, patching, Bangerter filter, and/or atropine penalization.
04CPT 92065 is not covered when used for visual information processing evaluations, CPT 92060 is not covered for the RightEye Sensorimotor test, and CPT 0687T and 0688T are not covered for the indications listed in the policy.
05Orthoptic vision therapy for other indications, such as anisometropic amblyopia, concussion, intermittent exotropia, and traumatic brain injury, is considered experimental, investigational, or unproven.

Codes mentioned

920609206592066H51.11H51.12H51.8H50.53H53.2H53.30H53.31

Original notice

Orthoptic Vision Therapy (CPB 0489, reviewed 2025-07-28)
aetna.com · Always check the source before changing claims.
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Related policy hubs

Aetna policiesOphthalmologyOptometryCode 92060Code 92065Code 92066Code H51.11Code H51.12Code H51.8Code H50.53Code H53.2Code H53.30Code H53.31

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