We’ll inform you when we’ve made a coverage decision. Are you a Louisiana provider? Check precertification info.*Legal notices Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its ...
Note for Idiopathic Short Stature (ISS): Aetna does not consider idiopathic short stature an illness, disease or injury. Accordingly, coverage would not be available under most plans, which provide coverage only for treatment of illness, injury or disease. If the benefit plan only covers treatment...
Note:Some plans exclude coverage of preventive services. Please check benefit plan descriptions for details. Medically necessary diagnostic PSA testing is covered regardless of whether the member has preventive service benefits. Experimental, Investigational, or Unproven The following interventions are consider...
the placement of orthodontic brackets and wires) is excluded from coverage under standard Aetna medical plans regardless of medical necessity. Please check benefit plan descriptions
All of the criteria for a power mobility device listed in the Basic Coverage Criteria section are met; and The member's home will accommodate a manual wheelchair with power assist device; and The member meets criteria for an ultra lightweight manual wheelchair; and The member is a full-time...
On December 8, 2008, the Centers for Medicare and Medicaid Services (CMS) issued a decision memorandum in response to a formal request for Menssana Research, Inc., to consider national coverage of the Heartsbreath test as an adjunct to the heart biopsy to detect grade 3 heart transplant ...
NHIC Corp. Local Coverage Determination (LCD) for Surgical Dressings (L11471). DME MAC Jurisdiction A. Hingham, MA: NHIC; revised June 1, 2013. Noridian Healthcare Solutions, LLC. Surgical dressings. Local Coverage Determination No. L33831. Durable Medical Equipment Medicare Administrative Contractor...
Aetna's medical necessity criteria for external infusion pumps for diabetes have been adapted, in part, from Medicare national policy on external insulin infusion pumps, as outlined in CMS's Coverage Issues Manual Section 60-14. Documentation of continued medical necessity of the external insulin ...
Aetna will not provide coverage for members withanyof the following exclusions: Pediatric members with TMB-H central nervous system cancers; Members who have experienced disease progression while on programmed death receptor-1 (PD-1) or PD-L1 inhibitor therapy (other than when used as second-line...
Applicable CPT / HCPCS / ICD-10 Codes Background References Policy Scope of Policy This Clinical Policy Bulletin addresses cosmetic surgery and procedures. Introduction Aetna plans exclude coverage of cosmetic surgery and procedures that are not medically necessary, but generally provide coverage when the...