Start free

PolicyChanges tracks payer policy changes for medical practices and tells you what to do before they take effect.

Create a free accountPolicy Monitoring is free. No card required.
← Back to list
AetnaCommercial · Coverage · Medical Policy · OphthalmologyMedium impact

Fundus Photography (CPB 0539, reviewed 2026-08-21)

Effective date
Not stated in the notice
Identified
Oct 2, 2026

Summary

Aetna's clinical policy bulletin considers fundus photography medically necessary only after a dilated fundoscopic exam shows one of the listed conditions, including diabetic retinopathy and/or macular edema, age-related macular degeneration, glaucoma and glaucoma suspects, and baseline screening for members starting long-term hydroxychloroquine or chloroquine therapy. Fundus photography of a normal retina is considered not medically necessary, and it is considered medically necessary no more than two times per year unless more frequent testing is justified in the medical record. Fundus photography as a screening tool without a dilated fundus exam, and fundus photography for all other indications not listed as covered, is considered experimental, investigational, or unproven.

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 · 7 steps
01Billing team: Claims for fundus photography (CPT 92250) need documentation of a dilated fundoscopic exam showing one of the listed indications.
02Document each photograph's eye, the date taken and the date reviewed, the findings and any changes from prior fundus photographs, an interpretation, and whether the treatment plan will change as a result.
03Fundus photographs without an interpretation are considered not medically necessary.
04Justify any testing above two times per year in the medical record.
05Baseline fundus photography before starting MEK inhibitor therapy (binimetinib, cobimetinib, trametinib) is considered not medically necessary.
06Records must be legible, include the patient's complete name and dates of service, and identify the physician or non-physician practitioner providing the care.
07For glaucoma, the interpretation must include the vertical and horizontal cup/disc ratio, the presence or absence of diffuse or focal pallor, asymmetry, and progression.

Codes mentioned

922509213292133921349213792270

Original notice

Fundus Photography (CPB 0539, reviewed 2026-08-21)
aetna.com · Always check the source before changing claims.
View original ↗

Related changes

See all Aetna changes →
Fundus Photography (CPB 0539, reviewed 2025-08-21)MediumNo effective date · Medical PolicyOptic Nerve and Retinal Imaging Methods (CPB 0344, reviewed 2026-10-20)MediumNo effective date · RadiologyOptic Nerve and Retinal Imaging Methods (CPB 0344, reviewed 2026-09-01)MediumNo effective date · RadiologyOptic Nerve and Retinal Imaging Methods (CPB 0344, reviewed 2026-05-26)MediumNo effective date · RadiologyBrowse every Aetna change in the policy list

Related policy hubs

Aetna policiesOphthalmologyCode 92250Code 92132Code 92133Code 92134Code 92137Code 92270

Summaries are AI-assisted. Always confirm against the original payer notice.

What is PolicyChanges

One workspace for payer rules, prior auth, coding and compliance

Medical practices use PolicyChanges to catch payer changes before they cause denials. Every change is summarized in plain English, with the codes involved, the date it takes effect and what to do.

Policy MonitoringPayer policy, prior auth and coding changes, filtered to your saved searchesOIG ScreeningStaff and vendors screened every month against OIG LEIE, SAM.gov and state Medicaid listsPrior Auth LookupKnow if a service needs prior authorization before you schedule itCredentialing TrackerLicenses, CAQH, Medicare revalidation and payer enrollments, with reminders before anything lapsesCompliance CenterKeep your HIPAA program documented and ready to show
Start freePolicy Monitoring is free. No card required.
Get alerts for changes like thisPolicy Monitoring is free. No card required.Create a free account