Glaucoma Testing — CPB 0622 | AETNA Coverage Update

TL;DR: Aetna, a CVS Health company, modified CPB 0622 governing glaucoma testing, effective October 8, 2025. Here's what billing teams need to do.

This update to the Aetna glaucoma testing coverage policy draws a sharper line between what's medically necessary and what's experimental. CPT codes 92020, 92081, 92082, 92083, 92133, and 92134 remain covered when selection criteria are met. A significant list of emerging technologies—including AI-based glaucoma detection, home tonometry, and visual evoked potential testing—are explicitly classified as experimental, investigational, or unproven under CPB 0622 Aetna. If your ophthalmology or optometry billing team is submitting any of the non-covered codes below, claim denials are coming.

Quick-Reference Table

Aetna Glaucoma Testing Coverage Criteria and Medical Necessity Requirements 2025

Aetna's coverage policy for glaucoma testing centers entirely on primary open-angle glaucoma (POAG). Three services clear the medical necessity bar: computerized visual field examination (CPT 92081, 92082, or 92083 depending on scope), gonioscopy (CPT 92020), and measurement of the optic nerve head and retinal nerve fiber layer (CPT 92133 or 92134).

That's a short list by design. Aetna is not covering the broader ecosystem of glaucoma monitoring technology that's emerged over the past decade. The policy is narrow and explicit—which is actually useful for your billing team, because there's little ambiguity about what gets paid.

For CPT 92133, Aetna covers scanning computerized ophthalmic diagnostic imaging of the posterior segment with interpretation and report. CPT 92134 covers the retina specifically. Both require that selection criteria are met—meaning you need the right diagnosis codes attached (primary open-angle glaucoma under the H40.11xx family) and documentation supporting medical necessity.

Prior authorization requirements are not explicitly called out in this version of the policy, but that doesn't mean your Aetna contracts are silent on it. Check your individual plan contracts before assuming these services are pre-approved. If you're billing a high volume of CPT 92083 (extended visual field examinations) or CPT 92133 for POAG patients, confirm your documentation supports medical necessity at the level the policy requires.

Reimbursement for these covered codes depends on your contracted rates, but the coverage policy itself is the gateway. Get the medical necessity documentation right first.

Aetna Glaucoma Testing Exclusions and Non-Covered Indications

This is where the policy gets consequential. Aetna classifies 12 distinct technologies and approaches as experimental, investigational, or unproven. That's not a hedge—it means no coverage, full stop.

AI-based glaucoma detection is explicitly excluded. This is worth flagging because AI diagnostic tools are increasingly marketed to ophthalmology practices. If you've started incorporating any AI-assisted glaucoma screening into your workflow, Aetna won't pay for it under this policy.

Home-based perimetry and home tonometry—including the Icare Home Tonometer specifically—are also excluded. CPT 99453, 99454, and 99457 (remote physiologic monitoring codes) appear in the non-covered group here. If your practice bills those codes for IOP monitoring in glaucoma patients covered by Aetna, stop. Those claims will deny.

Visual evoked potential (VEP) testing for glaucoma—including isolated-check VEP and multi-focal VEP—is classified as experimental. CPT 0464T is the relevant code. This matters because some practices bill VEP for early glaucomatous field defect detection, and this policy says Aetna won't pay for it in that context.

Corneal hysteresis measurement (CPT 92145) is also out. This one is worth watching because corneal hysteresis is gaining clinical traction. Aetna isn't there yet on coverage.

Continuous IOP monitoring (CPT 0329T) and ocular blood flow analysis (CPT 0198T) are excluded as well. Both carry an experimental designation under this policy, meaning no coverage is available for either service in glaucoma management.

The RETeval portable ERG device (CPT 92273 and 92274, along with CPT 0509T for pattern ERG) rounds out the exclusions. Electroretinography for glaucoma detection gets no coverage under this policy.

The real issue here is that practices on the clinical cutting edge are billing codes that Aetna has explicitly decided not to cover. That's a billing and compliance problem. Document your technology investments carefully, and don't bill Aetna for these services expecting payment.

Coverage Indications at a Glance

Aetna Glaucoma Testing Billing Guidelines and Action Items 2025

CPT, HCPCS, and ICD-10 Codes for Glaucoma Testing Under CPB 0622

Covered CPT Codes (When Selection Criteria Are Met)

Not Covered / Experimental Codes

Key ICD-10-CM Diagnosis Codes

Note: The full ICD-10 range under this policy spans 89 codes. Map your POAG diagnoses precisely to the correct H40.11xx subcategory, including laterality and stage. Unspecified codes will not strengthen a medical necessity argument if Aetna audits the claim.