Novel Injection Methods — CPB 0777 | AETNA Coverage Update

Aetna modified CPB 0777 covering novel injection methods, effective December 3, 2025. Here's what billing teams need to do.

Aetna, a CVS Health company, updated Clinical Policy Bulletin 0777 to clarify which injection-based procedures meet medical necessity and which it now classifies as experimental or non-covered. The policy directly affects CPT codes 67516, 0810T, and 0699T, plus HCPCS codes J3299 and C9759. If your practice bills for ophthalmic injections or vascular microinfusion procedures, this Aetna novel injection coverage policy determines whether those claims pay or deny.

Quick-Reference Table

Aetna Novel Injection Methods Coverage Criteria and Medical Necessity Requirements 2025

The CPB 0777 Aetna system draws a sharp line between two covered procedures and everything else. There are exactly two scenarios where Aetna considers a novel injection method medically necessary.

First: Supra-choroidal injection using triamcinolone acetonide injectable suspension (brand name Xipere) for macular edema associated with uveitis. This is covered under CPT 67516 and billed with HCPCS J3299 (triamcinolone acetonide [Xipere], 1 mg per unit). Aetna ties the medical necessity criteria for this indication to a separate policy — CPB 1000 — so your team must confirm the patient meets those criteria before submitting. Don't assume the diagnosis alone is sufficient.

Second: Sub-retinal injection of recombinant tissue plasminogen activator (rtPA) for sub-macular hemorrhage. This is covered under CPT 0810T, which describes a subretinal injection of a pharmacologic agent that includes vitrectomy and one or more retinotomies. If your retina surgeon performs this procedure on a patient with sub-macular hemorrhage (ICD-10 codes H35.60 through H35.63), you have a covered service — provided documentation supports the indication.

Those are the only two covered indications under this coverage policy. Every other supra-choroidal injection — regardless of the drug used — is experimental per Aetna's language. That's a critical distinction for practices exploring newer supra-choroidal drug delivery options beyond Xipere.

Prior authorization requirements for these procedures are governed by Aetna's standard ophthalmology prior auth protocols and, for Xipere specifically, by CPB 1000. Check that policy before billing 67516 and J3299. Missing a prior auth step here is a fast path to a claim denial.

Aetna Novel Injection Methods Exclusions and Non-Covered Indications

Two specific technologies get an explicit experimental designation in CPB 0777. Aetna is not hedging on these — they're clearly out.

Supra-choroidal injection of any agent other than Xipere is experimental, investigational, or unproven for all indications. The policy is explicit: the effectiveness of this delivery route has not been established beyond the single approved drug. If a physician is using supra-choroidal delivery for off-label agents, that reimbursement will not come from Aetna.

The Mercator Bullfrog micro-infusion device (billed under HCPCS C9759) is also experimental for direct adventitial delivery of diagnostic or therapeutic agents via blood vessel walls. Aetna cites a lack of evidence on safety and effectiveness. This affects vascular practices that may be billing C9759 for transcatheter intraoperative blood vessel microinfusion procedures.

CPT 0699T — injection into the posterior chamber of the eye — falls into the non-covered category for the indications listed in CPB 0777. This code is not covered, full stop.

The real issue here is exposure. If your practice has been billing C9759 or 0699T and receiving payment, those claims may now face retroactive scrutiny. Talk to your compliance officer before the effective date of December 3, 2025 about your claims history on these codes.

Coverage Indications at a Glance

Aetna Novel Injection Methods Billing Guidelines and Action Items 2025

Here's what your billing team and revenue cycle staff need to do before and after December 3, 2025.

CPT, HCPCS, and ICD-10 Codes for Novel Injection Methods Under CPB 0777

Covered CPT and HCPCS Codes (When Selection Criteria Are Met)

Not Covered / Experimental Codes

Key ICD-10-CM Diagnosis Codes

A note on 67516: this code appears in both the covered and non-covered columns depending on context. Aetna covers it specifically for Xipere administered to treat uveitic macular edema. The same code, used for any other drug delivered via supra-choroidal injection, is experimental. Your documentation has to make the drug identity and indication clear — the code alone won't save the claim.