Artificial Retina and Artificial Iris — CPB 0713 | AETNA Coverage Update

TL;DR: Aetna, a CVS Health company, reaffirmed and modified CPB 0713 on November 27, 2025, classifying all artificial retina and artificial iris devices as experimental and investigational — meaning CPT codes 0100T, 0472T, 0473T, 0616T, 0617T, 0618T, and 66683, plus HCPCS codes C1839, C1841, C1842, and L8608, are not covered for any indication listed in the policy. Here's what billing teams need to do.

If your ophthalmology or retinal surgery practice has been billing Aetna for prosthetic eye device implantation, this update is a hard stop. There is no covered pathway for artificial retina or artificial iris devices under CPB 0713 in the Aetna system. Claims will deny. Full stop.

The Aetna artificial retina and iris coverage policy draws a clear line: these devices — including the Argus II retinal prosthesis and the CustomFlex Artificial Iris — do not meet Aetna's standard for established clinical effectiveness. That determination applies across every diagnosis category covered in this bulletin, including congenital aniridia, traumatic iris defects, post-surgical aphakia, and diabetic retinopathy.

Quick-Reference Table

Aetna Artificial Retina and Artificial Iris Coverage Criteria and Medical Necessity Requirements 2025

There are no medical necessity criteria that unlock coverage here. That's the point of this policy.

CPB 0713 in the Aetna system does not offer a covered pathway for artificial retina or artificial iris devices under any clinical circumstances described in the bulletin. Aetna's position is that the effectiveness of these interventions has not been established — so there is no set of diagnosis codes, clinical documentation, or prior authorization process that gets you to a paid claim.

This matters because billing teams sometimes assume a blanket "experimental" classification still has covered carve-outs for specific indications or patient populations. Not here. The Aetna artificial retina and iris coverage policy applies the experimental designation uniformly across all 53 ICD-10-CM codes listed in the bulletin — from congenital iris abnormalities (Q13.0, Q13.1, Q13.2) to diabetic retinopathy (E08.311–E13.39 ranges) to retinal detachment and breaks (H33.001–H35.9).

Prior authorization is not a workaround. Submitting a prior auth request for CPT 0616T (iris prosthesis insertion) or CPT 0100T (subconjunctival retinal prosthesis receiver placement) will not result in approval under this policy. Don't spend your team's time on auth requests that the policy prohibits before the clinical review even starts.

Reimbursement for these procedures under Aetna commercial plans is effectively zero while CPB 0713 remains in its current form. If your practice is evaluating these devices for Aetna-insured patients, that financial reality needs to be part of the pre-procedure conversation.

Aetna Artificial Retina and Artificial Iris Exclusions and Non-Covered Indications

Everything in this policy is in the exclusion column. That's an unusual situation — but it's the one CPB 0713 creates.

Aetna specifically names two device categories as experimental, investigational, or unproven:

Artificial retina devices — the Argus II is cited by name. This covers the full device system, including internal components (billed under HCPCS C1841 and C1842) and external accessories (L8608). The associated procedure code, CPT 0100T for subconjunctival retinal prosthesis receiver and pulse generator placement, is not covered. Neither are the device evaluation and interrogation codes — CPT 0472T (initial programming of an intra-ocular retinal electrode array) and CPT 0473T (subsequent evaluation and interrogation of that array).

Artificial iris devices — the CustomFlex Artificial Iris is cited by name. The policy excludes coverage for anterior segment reconstruction, aniridia, post-operative or traumatic aphakia, and other iris defects. The non-covered procedure codes include CPT 0616T (iris prosthesis insertion, standalone), CPT 0617T (with crystalline lens removal and IOL insertion), CPT 0618T (with secondary IOL placement or IOL exchange), and CPT 66683 (iris prosthesis implantation with suture fixation). HCPCS C1839 covers the iris prosthesis device itself and is also not covered.

The real issue here is that CPT 66683 is a code some practices have embedded in ophthalmology charge capture for complex anterior segment reconstruction. If your team has been using 66683 in any context that involves an artificial iris device in Aetna patients, those claims are at risk of denial under this policy.

Coverage Indications at a Glance

Aetna Artificial Retina and Artificial Iris Billing Guidelines and Action Items 2025

The effective date is November 27, 2025. If your billing team hasn't already acted, act now.

If your practice has a high volume of complex anterior segment cases or participates in any clinical investigation of retinal prosthesis technology, talk to your compliance officer before the end of the year. The line between a covered anterior segment reconstruction and a non-covered artificial iris implantation can be thin in documentation — and Aetna's billing guidelines under CPB 0713 leave no room for ambiguity on the device type.

CPT, HCPCS, and ICD-10 Codes for Artificial Retina and Artificial Iris Under CPB 0713

Not Covered CPT Codes — All Indications Listed in CPB 0713

Not Covered HCPCS Codes — All Indications Listed in CPB 0713

Key ICD-10-CM Diagnosis Codes Referenced in CPB 0713

These are the diagnoses Aetna explicitly includes in scope. All carry the non-covered designation for artificial retina and iris devices.