TL;DR: Aetna, a CVS Health company, modified CPB 0749 covering anterior segment scanning computerized ophthalmic diagnostic imaging, effective November 27, 2025. CPT 92132 is not covered for any listed indication. Here's what billing teams need to do.
This update to the Aetna anterior segment OCT coverage policy draws a hard line: CPT 92132 (scanning computerized ophthalmic diagnostic imaging, anterior segment) gets no covered indications under CPB 0749 Aetna system. The policy also flags Pentacam, scanning laser ophthalmoscopy, and scanning laser polarimetry as lacking sufficient evidence. If your ophthalmology or optometry practice bills Aetna for anterior segment imaging, this policy will drive claim denials.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | Aetna, a CVS Health company |
| Policy | Anterior Segment Scanning Computerized Ophthalmic Diagnostic Imaging |
| Policy Code | CPB 0749 |
| Change Type | Modified |
| Effective Date | November 27, 2025 |
| Impact Level | High |
| Specialties Affected | Ophthalmology, Optometry, Ocular Oncology, Glaucoma Specialists |
| Key Action | Audit all CPT 92132 claims billed to Aetna and confirm no covered indication exists under this policy before billing |
Aetna Anterior Segment OCT Coverage Criteria and Medical Necessity Requirements 2025
The real issue here is that Aetna's coverage policy for anterior segment OCT doesn't have a "covered with criteria" tier. There is no list of approved indications for CPT 92132. The entire procedure is classified as experimental, investigational, or unproven for all indications.
That's an unusual policy structure. Most imaging coverage policies carve out at least some approved uses and restrict others. This one doesn't. Aetna's position is that the clinical value of anterior segment OCT has not been established — full stop.
Medical necessity documentation won't save a CPT 92132 claim under this policy. It doesn't matter how thorough your notes are or how clinically appropriate the imaging was. Aetna does not recognize a medical necessity pathway to coverage here. If you're billing Aetna members for anterior segment OCT and expecting reimbursement, you're billing against a policy that will deny every claim.
Prior authorization won't help either. There's no indication in CPB 0749 that prior authorization unlocks coverage for any anterior segment OCT use. When a payer classifies a procedure as experimental across all indications, prior auth is typically off the table. If your team has been seeking prior authorization for CPT 92132 under Aetna, stop — you're adding administrative work that won't produce coverage.
The policy also explicitly calls out three imaging technologies as non-covered for anterior segment structures (ciliary body, cornea, iris, and lens): Pentacam, scanning laser ophthalmoscopy (SLO), and scanning laser polarimetry (SLP). These don't have a separate billing code in the policy's "not covered" list, but the exclusion is explicit. If you're using these technologies for anterior segment imaging and billing Aetna, document that exclusion in your denial tracking.
Aetna Anterior Segment OCT Exclusions and Non-Covered Indications
The list of excluded indications in this policy is long — 22 specific clinical uses for anterior segment OCT alone. That breadth matters. It means Aetna has considered a wide range of clinical arguments for this procedure and rejected all of them.
Here are the specific clinical uses Aetna classifies as experimental or unproven under CPB 0749:
| # | Excluded Procedure |
|---|---|
| 1 | Assessment of Haab striae |
| 2 | Characterization of ocular surface changes in ocular graft-versus-host disease |
| 3 | Detection of glaucoma |
| 4 | Diagnosis of Descemet membrane detachment during cataract surgery |
| 5 | Diagnosis and management of pigmentary dispersion syndrome |
| 6 | Evaluation of anterior segment morphology of hyperopia |
| 7 | Evaluation of belantamab-associated superficial keratopathy |
| 8 | Evaluation of benign reactive lymphoid hyperplasia |
| 9 | Evaluation of blebs after filtering surgery |
| 10 | Evaluation of conjunctival amyloidosis |
| 11 | Evaluation of conjunctival hyperemia |
| 12 | Evaluation of conjunctival lymphoma |
| 13 | Evaluation of corneal and conjunctival tumors |
| 14 | Evaluation of ocular surface squamous neoplasia |
| 15 | Evaluation of post-operative opacification of intraocular lens |
| 16 | Evaluation of strabismus |
| 17 | Evaluation of the proximal lacrimal system |
| 18 | Identification of fungal infections with endophthalmitis after cataract surgery |
| 19 | Imaging of extra-ocular rectus muscle insertions for pre-operative planning |
| 20 | Management of Wilson disease |
| 21 | Prediction of post-operative outcomes following trabeculectomy |
| 22 | Quantification of corneal haziness |
A few of these stand out. Glaucoma detection is one of the most common reasons practices order anterior segment OCT — and Aetna says it's not covered. Cataract surgery is one of the most frequently billed ophthalmic procedures in the country, and Aetna excludes anterior segment OCT for Descemet membrane detachment diagnosis during cataract surgery and for post-operative IOL opacification evaluation.
The belantamab-associated superficial keratopathy exclusion is newer and worth flagging. Belantamab mafodotin (J9037) is a myeloma drug with known corneal toxicity. Monitoring patients on this drug with anterior segment OCT is a growing clinical practice. Aetna's position is that evidence doesn't support coverage for that monitoring use. If your practice manages oncology patients on belantamab, anterior segment OCT billing guidelines for Aetna now carry explicit denial risk.
The refractive surgery connection is also important. Aetna members are generally not eligible for Pentacam imaging when it's tied to refractive eye surgery (LASIK, S0800; photorefractive keratectomy, S0810; phakic IOL, S0596). Refractive procedures are typically excluded by contract. Any imaging done in connection with an excluded procedure is also excluded. That's a bundling denial waiting to happen if your team isn't flagging these cases at charge entry.
Coverage Indications at a Glance
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| Anterior segment OCT — all indications | Not Covered / Experimental | CPT 92132, ICD-10 varies by diagnosis | No covered indication exists under this policy |
| Glaucoma detection via anterior segment OCT | Not Covered | CPT 92132, H40.001–H42 | Classified experimental regardless of documentation |
| Descemet membrane detachment (cataract surgery) | Not Covered | CPT 92132, H18.331–H18.339 | Excluded even intraoperatively |
| Ocular graft-versus-host disease | Not Covered | CPT 92132, D89.810–D89.813 | Insufficient evidence per Aetna |
| Belantamab-associated superficial keratopathy | Not Covered | CPT 92132, J9037, H16.101–H16.109 | Monitoring use specifically excluded |
| Pigmentary dispersion syndrome | Not Covered | CPT 92132, H21.231–H21.239 | Experimental designation |
| Conjunctival/corneal tumors | Not Covered | CPT 92132, C69.0–C69.2, C69.10–C69.12 | Malignant and benign neoplasms both excluded |
| Ocular surface squamous neoplasia | Not Covered | CPT 92132 | Experimental |
| Quantification of corneal haziness | Not Covered | CPT 92132, H17.10–H17.13, H17.811–H17.9 | No coverage pathway |
| Conjunctival hyperemia | Not Covered | CPT 92132, H11.431–H11.439 | Experimental |
| Post-op IOL opacification | Not Covered | CPT 92132 | Excluded even for post-surgical evaluation |
| Trabeculectomy outcome prediction | Not Covered | CPT 92132, CPT 66170 | Pre-operative use not covered |
| Pentacam — anterior segment (all indications) | Not Covered | No specific CPT listed | Insufficient evidence |
| SLO / confocal laser scanning ophthalmoscopy | Not Covered | No specific CPT listed | Insufficient evidence |
| Scanning laser polarimetry (SLP) | Not Covered | No specific CPT listed | Insufficient evidence |
| Anterior segment imaging — refractive surgery workup | Not Covered / Excluded by Contract | S0596, S0800, S0810, CPT 65760–65771 | Imaging excluded when underlying surgery is excluded |
Aetna Anterior Segment OCT Billing Guidelines and Action Items 2025
The effective date of November 27, 2025 means this policy is already active. There's no runway left to wait and see.
| # | Action Item |
|---|---|
| 1 | Pull all CPT 92132 claims billed to Aetna in the last 90 days. Cross-reference those claims against the 22 excluded indications. If you've been billing anterior segment OCT for glaucoma detection, cataract surgery evaluation, or corneal tumor assessment, flag those for denial review now. |
| 2 | Update your charge capture to flag CPT 92132 for Aetna patients. Add a hard stop or warning at charge entry. Your billing team should know before the claim goes out that Aetna has no covered pathway for this procedure. |
| 3 | Implement patient notification for self-pay anterior segment OCT. If the procedure has clinical value for a specific patient, your practice may still perform it — but you need an advance beneficiary notice equivalent (ABN-style waiver for commercial payers) so the patient understands they'll pay out of pocket. Confirm your process with your compliance officer before collecting from patients. |
| 4 | Flag belantamab patients specifically. If you manage myeloma patients receiving J9037 and you're monitoring with anterior segment OCT, Aetna won't cover CPT 92132 for that use. Coordinate with the treating oncologist's billing team. Someone needs to counsel the patient on financial responsibility before imaging. |
| 5 | Audit any claims that bundled anterior segment OCT with refractive surgery codes. LASIK (S0800), photorefractive keratectomy (S0810), phakic IOL (S0596), and CPT codes 65760–65771 are explicitly referenced in this policy. If Aetna denied a refractive procedure and you also billed CPT 92132, expect that imaging claim to follow the surgery denial. Review those accounts for write-off accuracy. |
| 6 | Don't pursue prior authorization for CPT 92132 under Aetna. It won't produce an approval. Prior auth exists to confirm coverage criteria are met — when no coverage criteria exist, the PA process has no function. You'll waste time and give patients false hope. |
| 7 | Talk to your compliance officer if your practice has been routinely billing CPT 92132 to Aetna. Repeated billing of a procedure Aetna classifies as experimental — especially if you've been collecting reimbursement — creates audit exposure. Your compliance officer needs to know the scope of your current billing pattern before you stop. |
| Previous Version | Current Version |
|---|---|
| Coverage is considered experimental and investigational for all indications | Coverage is considered medically necessary when specific criteria are met |
| Prior authorization is not required | Prior authorization is required for initial treatment |
| Documentation must include clinical history | Documentation must include clinical history |
| Re-review every 24 months | Re-review every 12 months with updated clinical documentation |
CPT, HCPCS, and ICD-10 Codes for Anterior Segment Imaging Under CPB 0749
Not Covered CPT Codes Under CPB 0749
| Code | Type | Description | Status |
|---|---|---|---|
| 92132 | CPT | Scanning computerized ophthalmic diagnostic imaging, anterior segment, with interpretation and report | Not covered for any indication listed in CPB 0749 |
Key ICD-10-CM Diagnosis Codes Referenced in CPB 0749
| Code | Description |
|---|---|
| B48.8–B49 | Other specified and unspecified mycoses |
| C69.0 | Malignant neoplasm of conjunctiva |
| C69.1 | Malignant neoplasm of conjunctiva |
| C69.10 | Malignant neoplasm of cornea |
| C69.11 | Malignant neoplasm of cornea |
| C69.12 | Malignant neoplasm of cornea |
| C69.2 | Malignant neoplasm of conjunctiva |
| D31.10 | Benign neoplasm of cornea |
| D31.11 | Benign neoplasm of cornea |
| D31.12 | Benign neoplasm of cornea |
| D36.0 | Benign neoplasm of lymph nodes (benign reactive lymphoid hyperplasia) |
| D89.810 | Acute graft-versus-host disease (ocular) |
| D89.811 | Chronic graft-versus-host disease (ocular) |
| D89.812 | Acute on chronic graft-versus-host disease (ocular) |
| D89.813 | Graft-versus-host disease, unspecified (ocular) |
| E83.01 | Wilson's disease |
| E85.9 | Amyloidosis, unspecified (conjunctival amyloidosis) |
| H11.431–H11.439 | Conjunctival hyperemia |
| H16.101–H16.109 | Unspecified superficial keratitis (associated with belantamab) |
| H17.10–H17.13 | Central corneal opacity (quantification of corneal haziness) |
| H17.811–H17.9 | Other corneal scars and opacities (quantification of corneal haziness) |
| H18.331–H18.339 | Rupture in Descemet's membrane (Haab striae; Descemet membrane detachment during cataract surgery) |
| H21.231–H21.239 | Degeneration of iris, pigmentary (pigmentary dispersion syndrome) |
| H40.001–H42 | Glaucoma |
| H44.1–H44.7 | Purulent endophthalmitis (fungal infections post-cataract surgery) |
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