Critical Flicker Fusion (CPB 0860, reviewed 2025-12-24)

Effective immediately (policy dated 2025-12-24): Billing team must update claim submission rules in billing software to deny or reject any claims for Critical Flicker Fusion testing when billed to Aetna commercial plans. Front-line staff should update patient pre-visit notifications and encounter forms to alert providers that CFF testing is not a covered service for any of the listed indications (visual acuity diagnosis, hepatic encephalopathy, optic neuropathy, executive dysfunction, or surgical outcome prediction). Specifically: (1) Block CPT codes 99172 and 99173 when linked to CFF indications; (2) Deny claims with ICD-10 codes H25.011-H26.9, H35.30-H35.389, H46.00-H46.9, H47.011-H47.019, H53.141-H53.149, H53.8, K72.00-K72.91, and R41.844 when paired with CFF testing; (3) Update provider education materials noting that CFF remains experimental/unproven per Aetna policy; (4) Flag any submitted claims for CFF testing as non-covered prior to transmission to Aetna to prevent denials and patient billing issues. Providers should NOT order CFF testing for Aetna patients unless they are prepared to explain the non-covered status to patients upfront. Failure to implement these rules will result in claim denials and potential patient balance issues.