All PlansCoverageMedium impact
Age-Related Macular Degeneration (CPB 0765, reviewed 2026-10-14)
Aetna·Ophthalmology, Optometry, Occupational Therapy +1 more·Medical Policy
We identified it
Oct 15, 2026
Summary
Aetna's CPB 0765 for Age-Related Macular Degeneration (reviewed 2026-10-14) defines medical necessity criteria for covered ARMD treatments including anti-VEGF injections, photodynamic therapy, and implantable miniature telescope, while designating numerous diagnostic tests and experimental therapies as non-covered. The policy specifies covered CPT codes (67028, 67221, 67225) and lists non-covered codes (0378T, 0379T, 0506T, 0205U, 0936T, and polymorphism testing codes). This is a policy review update with no stated effective date change, meaning current coverage determinations remain in effect.
Action Required
Billing team should verify current claim processing alignment with Aetna's CPB 0765 coverage determinations. Confirm that claims for covered procedures (CPT 67028, 67221, 67225 for anti-VEGF injections and photodynamic therapy) are being processed without denial, and that claims for non-covered diagnostic codes (0378T, 0379T, 0506T, 0205U, 0936T for ForeseeHome monitoring, heterochromatic flicker photometry, genetic testing, and photobiomodulation) are being appropriately denied or require patient notification of out-of-pocket responsibility. Review implantable miniature telescope (IMT) cases to ensure all nine medical necessity criteria are documented and present in the clinical record before submission. No deadline is stated; treat this as confirmation of current policy applicability for Aetna members.