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Endothelial Cell Photography (CPB 0538, reviewed 2025-11-26)
Act
by Dec 26, 2025
Effective date
Jun 29, 2001
Identified
Aug 14, 2026
Summary
Aetna's updated CPB 0538 policy clarifies medical necessity criteria for endothelial cell photography (CPT 92286, 92287) for specific pre-surgical and corneal conditions. The policy establishes seven specific clinical indications where the procedure is covered, and designates it as an integral part of pre-surgical eye exams for cataract surgery when appropriate. All other indications remain experimental/investigational.
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What to do
by Dec 26, 2025 · 4 steps
01Billing team must review and implement updated medical necessity criteria for endothelial cell photography (CPT 92286, 92287) claims submitted to Aetna.
02Update billing software validation rules to accept claims ONLY when one of the seven documented indications is present: (1) extended wear contact lens fitting post-intraocular surgery, (2) secondary IOL implantation planned, (3) higher-risk corneal endothelium surgical procedure planned, (4) prior intraocular surgery with cataract surgery needed, (5) slit-lamp evidence of corneal edema, (6) slit-lamp evidence of endothelial dystrophy/Fuch's dystrophy, or (7) posterior polymorphous dystrophy or irido-corneal endothelium syndrome.
03Ensure provider documentation templates capture the specific clinical indication on encounter notes.
04For all other indications, flag claims as experimental/investigational and deny or require prior authorization per plan terms.
If missed: Failure to align with these criteria will result in claim denials from Aetna.
Codes mentioned
9228692287H18.10H18.11H18.12H18.13H18.14H18.15H18.16H18.17H18.18H18.19H18.20H18.21H18.22H18.23H18.511H18.512H18.513H18.519H18.591H18.592H18.593H18.599
Original notice
Endothelial Cell Photography (CPB 0538, reviewed 2025-11-26)
aetna.com · Always check the source before changing claims.
Related changes
See all Aetna changes →Endothelial Cell Photography (CPB 0538, reviewed 2026-08-26)MediumNo effective date · Medical PolicyCorneal Pachymetry (CPB 0681, reviewed 2026-10-26)LowNo effective date · Medical PolicyCorneal Pachymetry (CPB 0681, reviewed 2025-10-15)MediumNo effective date · Medical PolicyCorneal Graft and Amniotic Membrane Transplantation, Corneal Stromal Lenticule Transplantation, Limbal Stem Cell Transplantation, or Sural Nerve Grafting for Ocular Indications (CPB 0293, reviewed 2026-06-08)MediumNo effective date · Medical PolicyBrowse every Aetna change in the policy list
Related policy hubs
Aetna policiesOphthalmologyOptometryCode 92286Code 92287Code H18.10Code H18.11Code H18.12Code H18.13Code H18.14Code H18.15Code H18.16Code H18.17Code H18.18Code H18.19Code H18.20Code H18.21Code H18.22Code H18.23Code H18.511Code H18.512Code H18.513Code H18.519Code H18.591Code H18.592Code H18.593Code H18.599