Strabismus Repair

Aetna covers strabismus repair for children and for adults ≥18 only when diplopia is documented or peripheral vision is impaired by esotropia and restoration of ocular alignment is expected to restore fusion (covered ICD‑10 H49.x, H50.x and CPT codes 67311–67345 when criteria are met). The policy excludes procedures deemed cosmetic when fusion won’t improve and considers use of amniotic membrane, Ologen biodegradable collagen matrix implants (and related CPTs 65778–65780) experimental/investigational and not covered.

"Strabismus surgery is considered medically necessary for children diagnosed with strabismus."

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