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

Aetna modified CPB 0713, classifying both artificial retina and artificial iris devices as experimental and investigational, effective November 27, 2025. CPT codes 0100T, 0472T, 0473T, 0616T, 0617T, 0618T, and 66683—along with HCPCS codes C1839, C1841, C1842, and L8608—are all non-covered under this policy. Here's what billing teams need to do.

Aetna, a CVS Health company, updated its artificial retina and artificial iris coverage policy under CPB 0713. The policy draws a hard line: no covered indications exist for these devices. That means any claim you submit using these codes against an Aetna plan will deny—regardless of the diagnosis code attached.

If your ophthalmology or anterior segment reconstruction practice bills Aetna, this update deserves immediate attention. The affected patient populations include aniridia, traumatic iris defects, aphakia, retinitis pigmentosa, and diabetic retinopathy—all conditions where surgeons sometimes reach for these devices.

Quick-Reference Table

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

The short answer on Aetna artificial retina and artificial iris coverage policy is this: there are no covered indications. Aetna does not consider these devices medically necessary under any diagnosis. The policy doesn't offer a pathway to coverage even with prior authorization, because the payer's position is that clinical evidence hasn't established effectiveness.

This is a significant stance. The Argus II retinal prosthesis—the device explicitly named in the policy—received FDA approval over a decade ago. The CustomFlex Artificial Iris received FDA clearance in 2018. Yet Aetna's medical necessity standard requires established clinical effectiveness, and the payer has concluded neither device meets that bar.

The practical consequence is zero reimbursement. There's no appeals pathway built on medical necessity arguments when the payer has categorically classified the intervention as experimental. If your practice has been submitting these claims and occasionally winning on appeal, this policy update tightens that door considerably.

Don't expect prior authorization to unlock coverage here. When a payer classifies something as experimental and investigational, prior auth requests typically come back as non-covered—not just as denied but as categorically excluded. That distinction matters for how you counsel patients before surgery.

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

Aetna's CPB 0713 positions both device categories under a single experimental, investigational, or unproven classification. The policy names specific devices to remove any ambiguity.

Artificial retina devices — The Argus II is explicitly cited. This covers CPT 0100T (placement of subconjunctival retinal prosthesis receiver and pulse generator), CPT 0472T (device evaluation, interrogation, and initial programming of intra-ocular retinal electrode array), and CPT 0473T (device evaluation and interrogation of intra-ocular retinal electrode array). HCPCS C1841 (retinal prosthesis, all internal and external components), C1842 (retinal prosthesis add-on), and L8608 (miscellaneous external component for the Argus II system) round out the retinal prosthesis codes. All are non-covered.

Artificial iris devices — The CustomFlex Artificial Iris is named directly. The covered indications that surgeons most commonly pursue—anterior segment reconstruction, aniridia, post-operative or traumatic aphakia, and other iris defects—are each explicitly called out as non-covered. CPT codes 0616T, 0617T, 0618T, and 66683 all fall under the non-covered designation. HCPCS C1839 covers the iris prosthesis device itself and is equally excluded.

The real issue here is that the ICD-10 diagnosis codes associated with these procedures span a wide range of legitimate clinical conditions. Coloboma of the iris (Q13.0), absence of the iris (Q13.1), Rieger's anomaly (Q13.81), traumatic aphakia (H27.0–H27.3), diabetic retinopathy across all diabetes types (E08–E13 ranges), and retinal detachment codes (H33.001–H35.9) are all listed. But a valid diagnosis does not create a covered claim when the procedure itself is classified experimental. Matching your ICD-10 to the right code won't save these claims.

Coverage Indications at a Glance

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

The effective date of November 27, 2025 is your line in the sand. Here's exactly what to do before and after that date.

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

Not Covered CPT Codes

Not Covered HCPCS Codes

Key ICD-10-CM Diagnosis Codes

These are the diagnosis codes Aetna associates with this policy. A valid diagnosis in these ranges does not create coverage—the procedures remain excluded regardless.