67516 Insurance Policy Changes

Novel Injection Methods (CPB 0777, reviewed 2025-12-02)

Aetna's new Clinical Policy Bulletin 0777 establishes coverage criteria for novel ophthalmic injection methods. Specifically, supra-choroidal injection of triamcinolone acetonide (Xipere) for uveitic macular edema is now covered when criteria in CPB 1000 are met; sub-retinal rtPA injection for sub-macular hemorrhage is covered; but all other supra-choroidal agents and the Mercator Bullfrog micro-infusion device remain experimental/unproven and are not covered. Billing teams must immediately implement coverage rules to avoid claim denials for non-approved injection methods.