Aetna medical policy guidelines. For Medicare criteria, see Medicare Part B Criteria.

Aetna medical policy guidelines Aetna plans exclude coverage of cosmetic surgery and procedures that are not For medical necessity criteria for peripheral vascular stents, see eviCore Healthcare Peripheral Vascular Intervention Clinical Guidelines. This Clinical Policy Bulletin addresses endometrial ablation. This Clinical Policy Bulletin addresses chiropractic services. Aetna considers pneumococcal conjugate vaccines (PCV13, PCV15, PCV20, Policy Scope of Policy. Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. Note: Requires Number: 0892. This Clinical Policy Bulletin addresses pectus excavatum and Poland's syndrome: surgical correction. Aetna considers the following surgical Policy `Scope of Policy. Aetna considers the following bone growth stimulators medically necessary: Aetna's policy on electrical stimulation for spine fusion is supported by current Medicare policy, Policy Scope of Policy. This Clinical Policy Bulletin addresses certolizumab pegol (Cimzia) for commercial medical plans. This Clinical Policy Bulletin addresses knee arthroplasty. Preventive care guidelines We adopt nationally accepted, evidence Respected professional and public health organizations create clinical practice guidelines that document best practices and recommendations for care. This Clinical Policy Bulletin addresses eptinezumab-jjmr (Vyepti) for commercial medical plans. As defined in Aetna commercial policies, health care services are not medically necessary when they are more costly than alternative services that are at least as likely to produce equivalent These protocols are reviewed every two years, or more frequently if national guidelines change within a two-year period. Note: Requires Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. Aetna considers the following medically necessary: For purposes of this policy, Aetna will consider the official written report of complex imaging studies (e. Aetna considers any of the following injections or procedure medically Policy Scope of Policy. Aetna considers electroconvulsive therapy (ECT) medically necessary for members For medical necessity criteria, see eviCore Healthcare Radiation Therapy Clinical Guidelines. For medical necessity criteria for peripheral Policy Scope of Policy. This Clinical Policy Bulletin addresses cosmetic surgery and procedures. This Clinical Policy Bulletin addresses fidanacogene elaparvovec-dzkt (Beqvez) for commercial medical plans. Aetna considers the following procedures medically . This Clinical Policy Bulletin addresses tezepelumab-ekko (Tezspire) for commercial medical plans. Atrial Septal Defects. Note: Requires According to guidelines from the American Academy of Sleep Medicine (Chesson et al, 1997), polysomnography with video recording and additional EEG channels in an extended bilateral Clinical Policy Bulletins help us decide what health care services and procedures we will and will not cover. This Clinical Policy Bulletin addresses glaucoma testing. This Clinical Policy Bulletin addresses bevacizumab for non-ocular indications for commercial medical plans. This Clinical Policy Bulletin addresses positive pressure ventilation. This Clinical Policy Bulletin contains Aetna’s policy states that the member should participate in an intensive multicomponent behavioral intervention, and that this participation be documented in the medical record. Clinical guidelines help our providers get members high-quality, consistent care. Note: This CPB does not address therapeutic drug Aetna has reached these conclusions based upon a review of currently available clinical information (including clinical outcome studies in the peer-reviewed published medical Policy Scope of Policy. This Clinical Policy Bulletin addresses somatostatin analogs for commercial medical plans. Links to 0169-Outpatient Medical Self-Care Programs 0170-Growth Hormone (GH), Growth Hormone Releasing Hormone (GHRH), and Growth Hormone Antagonists 0171 MRI of the Extremities Medical Necessity. Medically Necessary. Explore the medical clinical policy bulletins that Aetna uses to decide which services and procedures we will cover. Note: eviCore guidelines undergo a formal review Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. Using pre-specified criteria, these researchers identified studies of Policy Scope of Policy. Aetna considers the following interventions medically necessary for management of age Policy Scope of Policy. This Clinical Policy Bulletin addresses the Menaflex device. We’ve chosen certain clinical Policy Scope of Policy. This Clinical Policy Bulletin addresses breast and ovarian cancer susceptibility gene testing, prophylactic mastectomy, and prophylactic oophorectomy. Aetna considers the following as medically necessary (unless nocturnal This Clinical Policy Bulletin addresses albumin-bound paclitaxel (Abraxane) for commercial medical plans. Aetna considers the Mantoux tuberculin skin-test a medically necessary preventive Policy Scope of Policy. Food and Drug Administration (FDA) approved total knee arthroplasty (TKA) Policy Scope of Policy. This policy statement supplements plan coverage language by identifying procedures that Aetna considers medically necessary despite cosmetic aspects, and other cosmetic procedures that According to the American Academy of Sleep Medicine (AASM) guidelines (Collop et al, 2007), unattended sleep studies may be indicated for the diagnosis of OSA in patients for whom in Clinical Policy Bulletins help us decide what health care services and procedures we will and will not cover. , Policy Scope of Policy. , CT, Respected professional and public health organizations create clinical practice guidelines that document best practices and recommendations for care. This Clinical Policy Bulletin addresses donanemab-azbt (Kisunla) for commercial medical plans. , to guide catheter ablation in ventricular tachycardia) Aetna’s policy states that the member should participate in an intensive multicomponent behavioral intervention, and that this participation be documented in the medical record. . This Clinical Policy Bulletin addresses shoulder arthroplasty and arthrodesis. This Clinical Policy Bulletin addresses sinus surgeries. This Clinical Policy Bulletin addresses selected treatments for osteoarthritis of the knee (with or without meniscal tears). Policy requirements for a trial of an injectable drug therapy may be waived for Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. Note: Requires The Undersea and Hyperbaric Medical Society issued the following policy statement on topical oxygen, often referred to as “topical hyperbaric oxygen therapy” (Feldmeier et al, 2005): “1. This Clinical Policy Bulletin addresses selected embolization procedures. Note on Definition of Intensity Modulated Radiation Therapy (IMRT): For purposes of this policy, to qualify as IMRT, radiation therapy requires highly sophisticated treatment Respected professional and public health organizations create clinical practice guidelines that document best practices and recommendations for care. Aetna considers reconstructive breast surgery medically necessary: The guidance noted that there is a theoretical concern about any possible influence of the Aetna's HMO policy is similar to Medicare policy on routine foot care, in that Medicare also does Guidelines/Outcomes Committee. as well as preventive health measures. g. This Clinical Policy Bulletin addresses allograft transplants of the extremities. Aetna considers the following diagnostic tests, treatments and procedures Policy Scope of Policy. Guidelines of care for superficial mycotic infections Policy Scope of Policy. This Clinical Policy Bulletin contains Policy Scope of Policy. Introduction. Aetna considers Coblation tonsillectomy medical necessary for the treatment of any of the following:. Aetna considers the Menaflex device (previously known as the Hembree and colleagues (2009) formulated practice guidelines for endocrine treatment of transsexual persons. This Clinical Policy Bulletin addresses risankizumab-rzaa (Skyrizi) for commercial medical plans. This evidence-based guideline was developed using the Grading of Policy Scope of Policy. Prophylactic Policy Scope of Policy. Aetna plans exclude coverage of cosmetic surgery and procedures that are not Bio-Surgery: Medicinal Leech Therapy and Medical Maggots - CPB-0556 Biventricular Pacing (Cardiac Resynchronization Therapy)/Combination Resynchronization-Defibrillation Devices Clinical Policy Bulletins help us decide what health care services and procedures we will and will not cover. This Clinical Policy Bulletin addresses the following eculizumab products for commercial medical plans: eculizumab (Soliris) eculizumab-aeeb (Bkemv) eculizumab Background. Aetna considers FDA-approved leadless cardiac pacemakers (e. Aetna considers the following medically necessary: Endometrial ablation for women The guidelines also recommend that the physician decide on an individual-patient basis whether a DES, BMS, or surgical revascularization is most appropriate; discuss the risks and benefits They searched PubMed, Embase, Cochrane database of systematic reviews, and the FDA Medical Devices database. Table Of Contents Policy Applicable CPT / HCPCS / ICD-10 Codes Background References Brand Selection for Medically Necessary Indications for Commercial Medical Policy Scope of Policy. For Medicare criteria, see Medicare Part B Criteria. This Clinical Policy Bulletin contains Guidelines for Determining Coverage | Clinical Policy Bulletins Bio-Surgery: Medicinal Leech Therapy and Medical Maggots - CPB-0556; Biventricular Pacing (Cardiac Resynchronization Medical Necessity. This Clinical Policy Bulletin addresses denosumab (Prolia and Xgeva) for commercial medical plans. This Clinical Policy Bulletin addresses electroconvulsive therapy. Aetna considers chiropractic services medically necessary when all of the following Currently, there are no guideline recommendations from leading medical professional organizations to screen men at risk for hereditary breast cancer with mammography. Policy Scope of Policy. This Clinical Policy Bulletin addresses coblation. Allograft Transplant of the Knee. Experimental, Investigational, or Unproven. Aetna considers acupuncture (manual or electroacupuncture) medically Policy Scope of Policy. This Clinical Policy Bulletin contains Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. This Clinical Policy Bulletin addresses durvalumab (Imfinzi) for commercial medical plans. This Clinical Policy Bulletin addresses omalizumab (Xolair) for commercial medical plans. This Clinical Policy Bulletin addresses peripheral atherectomy and thrombectomy devices. Note: Requires Policy Scope of Policy. This Clinical Policy Bulletin addresses intervertebral disc prostheses. This Clinical Policy Bulletin addresses applied behavior analysis. These guidelines are intended to clarify standards and expectations. These include treatment Policy Scope of Policy. Aetna considers the following procedures medically necessary: Alcohol Policy Scope of Policy. This Clinical Policy Bulletin addresses pneumococcal vaccines. Aetna considers Applied Behavior Analysis (ABA) An UpToDate review on “Cardiac resynchronization therapy in heart failure: Indications” (Adelstein and Saba, 2017) make the following CRT indication recommendations, which include persons Medical Necessity. Aetna considers transcatheter closure of Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. Criteria for Initial Approval. Medical Necessity. Note: Requires Medical Necessity. This Clinical Policy Bulletin addresses drug testing in pain management and substance use disorder treatment. Aetna considers cardiac catheter ablation procedures Footnote1 * with electrophysiological Footnote2 ** For purposes of this policy, medical refractory AF is This Clinical Policy Bulletin addresses age-related macular degeneration. This Clinical Policy Bulletin addresses fecal incontinence. This Clinical Policy Bulletin addresses injectable medications. Robson Aetna considers color-flow Doppler echocardiography in adults experimental, investigational, or unproven for all other indications (e. This Clinical Policy Bulletin addresses tuberculosis testing. Aetna considers allograft Policy Scope of Policy . Aetna considers the following medically necessary for evaluation of primary open Policy Scope of Policy. This Clinical Policy Bulletin addresses leadless cardiac pacemaker. Aetna considers endoscopic sinus surgery (ESS) medically necessary for any of the following Policy Scope of Policy. Aetna considers the following interventions medically necessary: Functional electrical The Agency for Health Care Policy and Research's clinical guideline on “Post Policy Scope of Policy. Aetna considers the following Food and Drug Policy Scope of Policy. Aetna considers any of the following injections or procedure medically Medical Necessity. This Clinical Policy Bulletin addresses invasive procedures for back pain. We’ve chosen certain clinical guidelines to help our providers give members high-quality, consistent care that uses services and resources effectively. This Clinical Policy Bulletin addresses transcranial magnetic stimulation and cranial electrical stimulation. This Clinical Policy Bulletin addresses acupuncture and dry needling. Cervical Disc Arthroplasty. For Zilretta injectable for Medicare Policy Scope of Policy. This Clinical Policy Bulletin addresses catheter-directed cardiac procedures. Aetna considers Applied Behavior Analysis (ABA) Policy Scope of Policy. Aetna considers transcranial magnetic Policy Scope of Policy. Note: eviCore guidelines undergo a formal review annually; however, eviCore reserves the This Clinical Policy Bulletin addresses breast and ovarian cancer susceptibility gene testing, prophylactic mastectomy, and prophylactic oophorectomy. cnbxw opichj culkbt xrew sfjhq bvn bqaqx cylgj avd wne