Retinopathy Telescreening Systems

Aetna covers retinopathy telescreening (CPT 92227, 92228; related HCPCS S3000) as a medical‑necessity alternative to ophthalmologist/optometrist screening for diabetic retinopathy and retinopathy of prematurity when the policy’s selection criteria and specified diabetes ICD‑10 codes without ophthalmic manifestations are met. Aetna considers AI‑only/AI‑based systems experimental/investigational for ROP (and not covered for the CPB indications), and deems telescreening investigational for monitoring progression of established diabetic retinopathy or for other retinal conditions (diabetes with ophthalmic‑manifestation/diabetic retinopathy ICD codes listed are not covered for disease‑progression monitoring).

"Screening diabetic retinopathy as an alternative to retinopathy screening by an ophthalmologist or optometrist (medical necessity per policy)."

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