Graves' Ophthalmopathy Treatments

Aetna covers orbital decompression, eye‑muscle and eyelid surgeries, orbital radiotherapy, applicable CPT/HCPCS procedures (including prism codes V2710/V2715/V2718 for strabismus) and teprotumumab (Tepezza) for thyroid eye disease when conservative measures and a trial of medications have failed; Tepezza is covered only for patients ≥18 with moderate‑to‑severe TED (active or inactive) as a one‑time 8‑infusion regimen (10 mg/kg then 20 mg/kg q3w ×7). Surgical treatment requires demonstrated stability of thyroid‑related orbitopathy, fat‑pad removal is considered cosmetic and not covered, repeat Tepezza series is excluded, and Tepezza requires precertification and site‑of‑care utilization management.

"Orbital decompression is indicated in patients with severe ophthalmopathy refractory to medications and radiotherapy, especially in the presence of marked proptosis and optic neuropathy."