Aetna · Clinical coverage policy

Aetna Optic Nerve and Retinal Imaging coverage criteria

Aetna covers optic nerve and retinal imaging (OCT, confocal laser scanning, nerve fiber layer analysis, stereophotogrammetry) to document the optic nerve head and retina in diagnosed diseases such as glaucoma, glaucoma suspects, diabetic retinopathy, and age-related macular degeneration, plus baseline imaging before chloroquine/hydroxychloroquine/vigabatrin therapy and screening/monitoring for specified drug toxicities. Imaging for glaucoma more than once per year, and routine screening of asymptomatic persons for glaucoma/retinal disease, are not covered. OCTA may substitute for fluorescein angiography for specified vascular and inflammatory conditions, but performing both OCTA and FA (or both OCT and OCTA) for the same indication is not medically necessary.

Policy CPB 0344 · Effective · Verify against the current Aetna policy before submitting — view source policy.

Payer

Aetna

Policy

CPB 0344

Prior auth

Confirm

Effective

January 1, 2026

This page reflects the coverage criteria captured from Aetna policy CPB 0344 and may not include every criterion, exception, or code — verify the complete bulletin before submitting.

What this means for the claim

The covered path, the next step to get it approved, and the specific way it denies — built only from this policy.

When does Aetna cover Optic Nerve and Retinal Imaging (CPT 92133), and what gets it denied?

Path
Aetna covers optic nerve and retinal imaging (OCT, confocal laser scanning, nerve fiber layer analysis, stereophotogrammetry) to document the optic nerve head and retina in diagnosed diseases such as glaucoma, glaucoma suspects, diabetic retinopathy, and age-related macular degeneration, plus baseline imaging before chloroquine/hydroxychloroquine/vigabatrin therapy and screening/monitoring for specified drug toxicities. Imaging for glaucoma more than once per year, and routine screening of asymptomatic persons for glaucoma/retinal disease, are not covered. OCTA may substitute for fluorescein angiography for specified vascular and inflammatory conditions, but performing both OCTA and FA (or both OCT and OCTA) for the same indication is not medically necessary. Coverage criteria include: Optic nerve and retinal imaging methods are considered medically necessary for documenting the appearance of the optic nerve head and retina in the following diagnoses/individuals (ANY of the listed conditions below).; Medically necessary indication: Age-related macular degeneration; Medically necessary indication: Cystoid macular edema following cataract surgery; Medically necessary indication: Diabetic retinopathy; Medically necessary indication: Dysthyroid optic neuropathy; Medically necessary indication: Epiretinal membrane; Medically necessary indication: Ethambutol-induced optic neuropathy; Medically necessary indication: Glaucoma; Medically necessary indication: Glaucoma suspects; Medically necessary indication: Macular edema; Medically necessary indication: Macular hole; Medically necessary indication: Non-arteritic anterior ischemic optic neuropathy; Medically necessary indication: Posterior vitreous detachment; Medically necessary indication: Pseudotumor cerebri; Medically necessary indication: Screening and monitoring for chloroquine, ethambutol, ezogabine, hydroxychloroquine, ponatinib, siponimod, and vigabatrin toxicity; Medically necessary indication: Sudden onset vitreous hemorrhage; Medically necessary indication: Vitreomacular traction and vitreomacular adhesion; Medically necessary indication: Vogt-Koyanagi-Harada (to quantify subretinal fluid and follow individuals during treatment); Medically necessary indication: Other diseases where the optic nerve head and retina have been affected; Accepted imaging methods considered medically necessary (ANY of): confocal laser scanning ophthalmoscopy; nerve fiber layer testing or analysis (confocal laser scanning tomography with polarimetry); optical coherence tomography (OCT); stereophotogrammetry; A baseline study of optic nerve and retinal imaging is considered medically necessary before initiation of chloroquine, hydroxychloroquine, or vigabatrin therapy.; Optical coherence tomography angiography (OCTA) is considered a medically necessary alternative to fluorescein angiography (FA) for: (1) diagnosis of chorioretinal vascular abnormalities related to age-related macular degeneration, choroidal neovascularization, and non-infectious vasculitis; (2) evaluation of acute exudative inflammation (e.g., toxoplasmosis and optic disc edema), diabetic retinopathy, and intra-ocular tumors; (3) monitoring treatment of conditions amenable to laser photocoagulation and/or anti-VEGF therapy, such as macular edema. Applies to 3 codes: 92133, 92134, 92137.
Action
Confirm prior-authorization status with Aetna before scheduling — it is code- and plan-specific, and this policy is not an exact authorization source.
Trap
Policy exclusions and limitations: Optic nerve imaging for glaucoma more frequently than once per year is considered not medically necessary.; Performance of both OCTA and FA (fluorescein angiography) for the same indication is considered not medically necessary.; Performance of both OCT and OCT-A (OCTA) for the same indication is considered not medically necessary.; Experimental, investigational, or unproven: optic nerve and retinal imaging as a biomarker for peripheral artery disease; Experimental, investigational, or unproven: imaging for cataracts; Experimental, investigational, or unproven: imaging for dry eye diseases; Experimental, investigational, or unproven: evaluation of neurodegeneration pattern in individuals with intra-cranial tumors; Experimental, investigational, or unproven: evaluation of Parinaud oculoglandular syndrome (cat scratch disease); Experimental, investigational, or unproven: evaluation of schizophrenia spectrum disorders; Experimental, investigational, or unproven: evaluation of visual snow syndrome; Experimental, investigational, or unproven: imaging following intra-ocular lens (IOL) exchange following IOL dislocation; Experimental, investigational, or unproven: imaging of retina as a biomarker for neurodegeneration in frontotemporal degeneration, multiple sclerosis, and optic neuritis; Experimental, investigational, or unproven: imaging for ocular histoplasmosis; Experimental, investigational, or unproven: imaging for posterior capsule opacification; Experimental, investigational, or unproven: routine screening of asymptomatic persons for glaucoma and other retinal diseases; Experimental, investigational, or unproven: screening/monitoring of persons on fingolimod (Gilenya); Experimental, investigational, or unproven: patient-initiated image capture and transmission to a remote surveillance center via an OCT device; Experimental, investigational, or unproven: OCTA for diagnosing and monitoring glaucoma; Experimental, investigational, or unproven: ultrasonographic (US) assessment of optic nerve sheath diameter (ONSD) as a screening tool for intracranial hypertension in traumatic brain injury; Experimental, investigational, or unproven: ultrasonographic (US) assessment of optic nerve sheath diameter (ONSD) for assessment of intracranial pressure in aneurysmal subarachnoid hemorrhage. Claims may be denied when the requested service falls under these.

Source: Aetna CPB 0344 — Optic Nerve and Retinal Imaging

Coverage criteria

  • Optic nerve and retinal imaging methods are considered medically necessary for documenting the appearance of the optic nerve head and retina in the following diagnoses/individuals (ANY of the listed conditions below).
  • Medically necessary indication: Age-related macular degeneration
  • Medically necessary indication: Cystoid macular edema following cataract surgery
  • Medically necessary indication: Diabetic retinopathy
  • Medically necessary indication: Dysthyroid optic neuropathy
  • Medically necessary indication: Epiretinal membrane
  • Medically necessary indication: Ethambutol-induced optic neuropathy
  • Medically necessary indication: Glaucoma
  • Medically necessary indication: Glaucoma suspects
  • Medically necessary indication: Macular edema
  • Medically necessary indication: Macular hole
  • Medically necessary indication: Non-arteritic anterior ischemic optic neuropathy
  • Medically necessary indication: Posterior vitreous detachment
  • Medically necessary indication: Pseudotumor cerebri
  • Medically necessary indication: Screening and monitoring for chloroquine, ethambutol, ezogabine, hydroxychloroquine, ponatinib, siponimod, and vigabatrin toxicity
  • Medically necessary indication: Sudden onset vitreous hemorrhage
  • Medically necessary indication: Vitreomacular traction and vitreomacular adhesion
  • Medically necessary indication: Vogt-Koyanagi-Harada (to quantify subretinal fluid and follow individuals during treatment)
  • Medically necessary indication: Other diseases where the optic nerve head and retina have been affected
  • Accepted imaging methods considered medically necessary (ANY of): confocal laser scanning ophthalmoscopy; nerve fiber layer testing or analysis (confocal laser scanning tomography with polarimetry); optical coherence tomography (OCT); stereophotogrammetry
  • A baseline study of optic nerve and retinal imaging is considered medically necessary before initiation of chloroquine, hydroxychloroquine, or vigabatrin therapy.
  • Optical coherence tomography angiography (OCTA) is considered a medically necessary alternative to fluorescein angiography (FA) for: (1) diagnosis of chorioretinal vascular abnormalities related to age-related macular degeneration, choroidal neovascularization, and non-infectious vasculitis; (2) evaluation of acute exudative inflammation (e.g., toxoplasmosis and optic disc edema), diabetic retinopathy, and intra-ocular tumors; (3) monitoring treatment of conditions amenable to laser photocoagulation and/or anti-VEGF therapy, such as macular edema

Covered codes

Codes listed in this Aetna policy. Check each one's prior-authorization verdict and Medicare rate:

Frequently asked questions

When does Aetna cover Optic Nerve and Retinal Imaging (CPT 92133), and what gets it denied?
Aetna covers optic nerve and retinal imaging (OCT, confocal laser scanning, nerve fiber layer analysis, stereophotogrammetry) to document the optic nerve head and retina in diagnosed diseases such as glaucoma, glaucoma suspects, diabetic retinopathy, and age-related macular degeneration, plus baseline imaging before chloroquine/hydroxychloroquine/vigabatrin therapy and screening/monitoring for specified drug toxicities. Imaging for glaucoma more than once per year, and routine screening of asymptomatic persons for glaucoma/retinal disease, are not covered. OCTA may substitute for fluorescein angiography for specified vascular and inflammatory conditions, but performing both OCTA and FA (or both OCT and OCTA) for the same indication is not medically necessary. Coverage criteria include: Optic nerve and retinal imaging methods are considered medically necessary for documenting the appearance of the optic nerve head and retina in the following diagnoses/individuals (ANY of the listed conditions below).; Medically necessary indication: Age-related macular degeneration; Medically necessary indication: Cystoid macular edema following cataract surgery; Medically necessary indication: Diabetic retinopathy; Medically necessary indication: Dysthyroid optic neuropathy; Medically necessary indication: Epiretinal membrane; Medically necessary indication: Ethambutol-induced optic neuropathy; Medically necessary indication: Glaucoma; Medically necessary indication: Glaucoma suspects; Medically necessary indication: Macular edema; Medically necessary indication: Macular hole; Medically necessary indication: Non-arteritic anterior ischemic optic neuropathy; Medically necessary indication: Posterior vitreous detachment; Medically necessary indication: Pseudotumor cerebri; Medically necessary indication: Screening and monitoring for chloroquine, ethambutol, ezogabine, hydroxychloroquine, ponatinib, siponimod, and vigabatrin toxicity; Medically necessary indication: Sudden onset vitreous hemorrhage; Medically necessary indication: Vitreomacular traction and vitreomacular adhesion; Medically necessary indication: Vogt-Koyanagi-Harada (to quantify subretinal fluid and follow individuals during treatment); Medically necessary indication: Other diseases where the optic nerve head and retina have been affected; Accepted imaging methods considered medically necessary (ANY of): confocal laser scanning ophthalmoscopy; nerve fiber layer testing or analysis (confocal laser scanning tomography with polarimetry); optical coherence tomography (OCT); stereophotogrammetry; A baseline study of optic nerve and retinal imaging is considered medically necessary before initiation of chloroquine, hydroxychloroquine, or vigabatrin therapy.; Optical coherence tomography angiography (OCTA) is considered a medically necessary alternative to fluorescein angiography (FA) for: (1) diagnosis of chorioretinal vascular abnormalities related to age-related macular degeneration, choroidal neovascularization, and non-infectious vasculitis; (2) evaluation of acute exudative inflammation (e.g., toxoplasmosis and optic disc edema), diabetic retinopathy, and intra-ocular tumors; (3) monitoring treatment of conditions amenable to laser photocoagulation and/or anti-VEGF therapy, such as macular edema. Applies to 3 codes: 92133, 92134, 92137. Confirm prior-authorization status with Aetna before scheduling — it is code- and plan-specific, and this policy is not an exact authorization source. Policy exclusions and limitations: Optic nerve imaging for glaucoma more frequently than once per year is considered not medically necessary.; Performance of both OCTA and FA (fluorescein angiography) for the same indication is considered not medically necessary.; Performance of both OCT and OCT-A (OCTA) for the same indication is considered not medically necessary.; Experimental, investigational, or unproven: optic nerve and retinal imaging as a biomarker for peripheral artery disease; Experimental, investigational, or unproven: imaging for cataracts; Experimental, investigational, or unproven: imaging for dry eye diseases; Experimental, investigational, or unproven: evaluation of neurodegeneration pattern in individuals with intra-cranial tumors; Experimental, investigational, or unproven: evaluation of Parinaud oculoglandular syndrome (cat scratch disease); Experimental, investigational, or unproven: evaluation of schizophrenia spectrum disorders; Experimental, investigational, or unproven: evaluation of visual snow syndrome; Experimental, investigational, or unproven: imaging following intra-ocular lens (IOL) exchange following IOL dislocation; Experimental, investigational, or unproven: imaging of retina as a biomarker for neurodegeneration in frontotemporal degeneration, multiple sclerosis, and optic neuritis; Experimental, investigational, or unproven: imaging for ocular histoplasmosis; Experimental, investigational, or unproven: imaging for posterior capsule opacification; Experimental, investigational, or unproven: routine screening of asymptomatic persons for glaucoma and other retinal diseases; Experimental, investigational, or unproven: screening/monitoring of persons on fingolimod (Gilenya); Experimental, investigational, or unproven: patient-initiated image capture and transmission to a remote surveillance center via an OCT device; Experimental, investigational, or unproven: OCTA for diagnosing and monitoring glaucoma; Experimental, investigational, or unproven: ultrasonographic (US) assessment of optic nerve sheath diameter (ONSD) as a screening tool for intracranial hypertension in traumatic brain injury; Experimental, investigational, or unproven: ultrasonographic (US) assessment of optic nerve sheath diameter (ONSD) for assessment of intracranial pressure in aneurysmal subarachnoid hemorrhage. Claims may be denied when the requested service falls under these.
Does Aetna require prior authorization for Optic Nerve and Retinal Imaging?
Confirm prior-authorization status with Aetna before scheduling — it is code- and plan-specific, and this policy is not an exact authorization source.
What does Aetna exclude for Optic Nerve and Retinal Imaging?
Policy exclusions and limitations: Optic nerve imaging for glaucoma more frequently than once per year is considered not medically necessary.; Performance of both OCTA and FA (fluorescein angiography) for the same indication is considered not medically necessary.; Performance of both OCT and OCT-A (OCTA) for the same indication is considered not medically necessary.; Experimental, investigational, or unproven: optic nerve and retinal imaging as a biomarker for peripheral artery disease; Experimental, investigational, or unproven: imaging for cataracts; Experimental, investigational, or unproven: imaging for dry eye diseases; Experimental, investigational, or unproven: evaluation of neurodegeneration pattern in individuals with intra-cranial tumors; Experimental, investigational, or unproven: evaluation of Parinaud oculoglandular syndrome (cat scratch disease); Experimental, investigational, or unproven: evaluation of schizophrenia spectrum disorders; Experimental, investigational, or unproven: evaluation of visual snow syndrome; Experimental, investigational, or unproven: imaging following intra-ocular lens (IOL) exchange following IOL dislocation; Experimental, investigational, or unproven: imaging of retina as a biomarker for neurodegeneration in frontotemporal degeneration, multiple sclerosis, and optic neuritis; Experimental, investigational, or unproven: imaging for ocular histoplasmosis; Experimental, investigational, or unproven: imaging for posterior capsule opacification; Experimental, investigational, or unproven: routine screening of asymptomatic persons for glaucoma and other retinal diseases; Experimental, investigational, or unproven: screening/monitoring of persons on fingolimod (Gilenya); Experimental, investigational, or unproven: patient-initiated image capture and transmission to a remote surveillance center via an OCT device; Experimental, investigational, or unproven: OCTA for diagnosing and monitoring glaucoma; Experimental, investigational, or unproven: ultrasonographic (US) assessment of optic nerve sheath diameter (ONSD) as a screening tool for intracranial hypertension in traumatic brain injury; Experimental, investigational, or unproven: ultrasonographic (US) assessment of optic nerve sheath diameter (ONSD) for assessment of intracranial pressure in aneurysmal subarachnoid hemorrhage. Claims may be denied when the requested service falls under these.

Source

Aetna CPB 0344 — Optic Nerve and Retinal Imaging

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Coverage disclaimer

This page summarizes Aetna clinical-coverage criteria extracted from policy CPB 0344 for educational purposes. Coverage policies change and vary by individual plan. Always verify against Aetna's current policy before performing a procedure or submitting a claim. d3rx is not responsible for claim denials or reimbursement issues.