← Back to list
Endothelial Cell Photography (CPB 0538, reviewed 2026-08-26)
Effective date
Not stated in the notice
Identified
Oct 1, 2026
Summary
Aetna's Endothelial Cell Photography policy (CPB 0538) clarifies medical necessity criteria for CPT codes 92286 and 92287 when used to assess corneal endothelial cell counts prior to ocular surgery. The policy covers seven specific clinical indications (pre-fitting extended wear contacts post-surgery, secondary IOL implantation, high-risk corneal procedures, previous intraocular surgery requiring cataract repair, corneal edema, endothelial dystrophy, and posterior polymorphous dystrophy) and designates the procedure as experimental/investigational for all other uses.
Get alerts when payers change rules like this one
We check Aetna and other payers every day and email you when a change matches your specialty and state.
Get Aetna alertsPolicy Monitoring is free. No card required.
What to do
Action · 5 steps
01Billing team must update claim submission logic to enforce Aetna's seven medical necessity criteria before approving payment for CPT 92286 and 92287.
02Verify one of the following applies: (1) extended wear contact lens fitting post-intraocular surgery, (2) secondary IOL implantation planned, (3) procedure with high corneal endothelium risk, (4) prior intraocular surgery with cataract surgery needed, (5) slit-lamp evidence of corneal edema, (6) slit-lamp evidence of endothelial dystrophy (Fuch's), or (7) posterior polymorphous dystrophy or irido-corneal endothelium syndrome documented.
03Add diagnostic code validation to system to ensure claims match covered ICD-10 codes (H18.10–H18.239, H18.511–H18.519, H18.591–H18.599).
04Flag claims using CPT 92286/92287 without one of these seven conditions as experimental/unproven and deny or refer to medical review.
05Educate ophthalmology providers that endothelial cell photography is considered integral to pre-surgical eye exams for cataract surgery when cataracts are the only visual problem, regardless of technique used.
Codes mentioned
9228692287H18.10H18.239H18.511H18.519H18.591H18.599
Original notice
Endothelial Cell Photography (CPB 0538, reviewed 2026-08-26)
aetna.com · Always check the source before changing claims.
Related changes
See all Aetna changes →Endothelial Cell Photography (CPB 0538, reviewed 2025-11-26)MediumEffective Jun 29, 2001 · 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 PolicyComputerized Corneal Topography (CPB 0130, reviewed 2026-03-26)MediumNo effective date · Medical PolicyBrowse every Aetna change in the policy list