CommercialCoverageMedium impact
Quantitative Pupillometry/Pupillography (CPB 0879, reviewed 2025-12-29)
Aetna·Neurology, Neurosurgery, Critical Care +9 more·Medical Policy
Effective date
Dec 29, 2025
We identified it
Aug 14, 2026
Summary
Aetna has classified quantitative pupillometry/pupillography (CPT 95919) and chromatic pupillography as experimental, investigational, or unproven for all listed indications, effective immediately. This policy denies coverage for these procedures across a comprehensive list of clinical applications including neurological, ophthalmological, and systemic disease monitoring. Billing teams must implement claims denial protocols for CPT 95919 when billed with any of the specified ICD-10 diagnosis codes.
Action Required
Immediately: Billing team must implement claims denial logic in billing software to deny CPT 95919 (Quantitative pupillometry with physician or other qualified health care professional interpretation and report, unilateral or bilateral) when submitted with any of the ICD-10 diagnosis codes listed in the policy (including but not limited to: H40.001-H42 for glaucoma, H35.30-H35.3293 for age-related macular degeneration, G30.0-G30.9 for Alzheimer's disease, H46.00-H46.9 for optic neuritis, H47.211-H47.219 for optic nerve atrophy, F32.0-F32.A for depression, G20.A1-G21.9 for Parkinson's disease, and I50.1-I50.9 for heart failure, among others). Update encounter templates and provider education materials to communicate that Aetna considers these procedures experimental and will not cover them. Flag all claims containing CPT 95919 for manual review against the comprehensive exclusion list before submission. Train billing staff that claims submitted with these code combinations will be denied without prior authorization, and prior authorization will not override the experimental/investigational determination. Create a reference guide mapping CPT 95919 to the full list of non-covered ICD-10 codes for staff reference.