Search by CPT code Use our tool to check if we require precertification. You can also learn if there's a special program. Number of codes to search? Precertification Medical preferred drugs When is precertification required? Precertification applies to all benefit plans that have a pre...
Annual digital rectal examination (DRE) as a service. 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, Investigati...
The authors concluded that for patients with H1N1-related ARDS, referral and transfer to an ECMO center was associated with lower hospital mortality compared with matched non-ECMO-referred patients.In an editorial that accompanied the afore-mentioned study, Checkley (2011) stated that "the study by...
CPT codes not covered for indications listed in the CPB: Thermal therapy (e.g., radiofrequency (ThermiVa and Viveve procedures) and laser), Laviv (azficel-hyphenT) -hyphen no specific code: 0419T Destruction neurofibroma, extensive, (cutaneous, dermal extending into subcutaneous); face, head a...
For plans without this exclusion, androgens and anabolic steroids as well as other medical interventions for performance enhancement are not covered because performance enhancement of non-diseased individuals is not considered treatment of disease or injury. Please check benefit plan descriptions for ...
No specific code Other HCPCS codes related to the CPB: A4450 Tape, non-hyphenwaterproof, per 18 square inches A4452 Tape, waterproof, per 18 square inches Low dye strapping/strapping of the chest: CPT codes not covered for indications listed in the CPB: Low dye strapping/strapping of the ...
One example is a power seating system. When this is provided, the base code used should be that with a sling/solid seat/back. Another example is the provision of an expandable controller when the base code includes a non-expandable controller but is capable of an upgrade....
Please check benefit plan descriptions for details. Weight Reduction Devices Aetna considers the FDA-cleared weight reduction device, Plenity (Gelesis, Inc.), as medically necessary to aid in weight management in overweight and obese adults with a Body Mass Index (BMI) of 25-40 kg/m2, when ...
Applicable CPT / HCPCS / ICD-10 Codes Background References Policy Scope of Policy This Clinical Policy Bulletin addresses gender affirming surgery. Note: Some plans may cover gender affirming procedures in addition to the following policy. Please check the specific benefit plan documents. Medical ...
. This is usually used in the transition of the member from hospital to home and is an extension of case management services.Note:In Aetna HMO and QPOS plans, such short-term speech therapy accumulates towards the 60-day limit or other applicable rehabilitation benefit limits. Please check ...