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AetnaAll Plans · Coverage · Radiology · Ophthalmology, NeurologyMedium impact

Optic Nerve and Retinal Imaging Methods (CPB 0344, reviewed 2026-09-01)

Effective date
Not stated in the notice
Identified
Sep 29, 2026

Summary

Aetna considers optic nerve and retinal imaging medically necessary for documenting the appearance of the optic nerve head and retina in listed conditions, including age-related macular degeneration, diabetic retinopathy, glaucoma, glaucoma suspects, macular edema and macular hole. Accepted methods are confocal laser scanning ophthalmoscopy, nerve fiber layer testing, optical coherence tomography (OCT) and stereophotogrammetry, and optic nerve imaging for glaucoma more frequently than once per year is considered not medically necessary. OCT angiography (OCTA) is considered medically necessary as an alternative to intravenous fluorescein angiography (IVFA) for listed retinal conditions, but performing both OCTA and IVFA, or both OCT and OCTA, for the same indication is considered not medically necessary.

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What to do

Action · 6 steps
01Billing team: Bill CPT 92133, 92134 and 92137 only when the policy's selection criteria are met for the listed diagnoses.
02CPT 0469T, 0604T, 0605T and 0606T are not covered for the indications listed in the policy.
03Limit optic nerve imaging for glaucoma to once per year, because imaging more frequently is considered not medically necessary.
04Before starting chloroquine, hydroxychloroquine or vigabatrin therapy, a baseline optic nerve and retinal imaging study is considered medically necessary, and annual screening should begin after 5 years of use or sooner with unusual risk factors.
05Do not bill both OCTA and IVFA, or both OCT and OCTA, for the same indication, because performing both is considered not medically necessary.
06Routine screening of asymptomatic persons for glaucoma and other retinal diseases, and OCTA for diagnosing or monitoring glaucoma, are considered experimental, investigational or unproven.

Codes mentioned

921339213492137

Original notice

Optic Nerve and Retinal Imaging Methods (CPB 0344, reviewed 2026-09-01)
aetna.com · Always check the source before changing claims.
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Related policy hubs

Aetna policiesOphthalmologyNeurologyCode 92133Code 92134Code 92137

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