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Novel Injection Methods (CPB 0777, reviewed 2026-10-27)
Effective date
Not stated in the notice
Identified
Nov 4, 2026
Previous versions
- Novel Injection Methods (CPB 0777, reviewed 2025-12-02) · published Dec 2, 2025
Summary
Aetna's CPB 0777 (reviewed 2026-10-27) clarifies coverage for novel injection methods in ophthalmology. Triamcinolone acetonide (Xipere) via suprachoroidal injection is covered for macular edema associated with uveitis when CPB 1000 criteria are met; all other suprachoroidal agents are experimental/unproven and not covered. Subretinal rtPA injection for sub-macular hemorrhage is covered when criteria are met. The Mercator Bullfrog micro-infusion device remains experimental/unproven and not covered.
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What to do
Action · 5 steps
01REQUIREMENTS:
1. For Triamcinolone Acetonide (Xipere) via suprachoroidal injection (CPT 67516, HCPCS J3299):
- Obtain prior authorization before scheduling or billing for Aetna members
- Billing team: Update charge entry and claim edits to attach documentation showing the patient meets criteria in Aetna CPB 1000 (Triamcinolone Acetonide Injectable Suspension)
- Claims without prior auth and supporting documentation will be denied
2.
02For all other suprachoroidal pharmacologic agents (CPT 67516, CPT 0699T, HCPCS C9759):
- Stop billing these codes to Aetna members for any indication; these services are not covered as experimental/investigational
- Inform providers and front desk staff that Aetna does not cover suprachoroidal injection of agents other than triamcinolone for uveitic macular edema
- If a patient still wants the service, follow Aetna's patient waiver or billing procedures per the plan documents
3.
03For subretinal rtPA injection (CPT 0810T) for sub-macular hemorrhage (ICD-10 H35.60–H35.63):
- Obtain prior authorization before scheduling or billing for Aetna members
- Billing team: Update charge entry to ensure claims include appropriate ICD-10 codes (H35.60, H35.61, H35.62, or H35.63) and documentation of sub-macular hemorrhage
- Claims without prior auth will be denied
4.
04For Mercator Bullfrog micro-infusion device (HCPCS C9759):
- Stop billing this code to Aetna members; the device is experimental/unproven and not covered
- Inform providers that Aetna does not cover adventitial delivery via this device
- If a patient still wants the service, follow Aetna's patient waiver or billing procedures
5.
05Verify reference to CPB 1000 criteria:
- Billing team: Maintain a copy of Aetna CPB 1000 (Triamcinolone Acetonide Injectable Suspension) to confirm selection criteria for Xipere coverage before submitting claims or requesting prior auth
Codes mentioned
67516J3299C9759H35.81H35.60H35.61H35.62H35.63
Original notice
Novel Injection Methods (CPB 0777, reviewed 2026-10-27)
aetna.com · Always check the source before changing claims.
Related changes
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