You might see the groups listed as generic, brand-name, or preferred brand-name drugs. Generic drugs often have lower copays. Brand-name drugs have higher copays. Dual eligibles (Medicare) These are people who can get benefits through two plans: Medicare and Medicaid. Duplicate coverage This...
Medicare Part A and Part B. Medicare Advantage is a bundled alternative to Original Medicare, provided by private insurance companies like Aetna, that includes Medicare Part A, Part B and usually Medicare Part D.
Aetna considers tracheostomy medically necessary for those members with the most severe OSA not manageable by other interventions. Requests for tracheostomy for OSA are subject to medical review.Note: Aetna follows Medicare DME MAC rules for the medically necessary quantity of tracheostomy supplies for O...
the Expanded Disability Status Scale [EDSS], disease duration, processing speed) and were not affected by fatigue levels. They considered the tested dual-tasking assessment device suitable for routine clinical neuropsychological assessments of dual-tasking abilities. The authors concluded...
Policy Scope of Policy This Clinical Policy Bulletin addresses pembrolizumab (Keytruda) for commercial medical plans. For Medicare criteria, seeMedicare Part B Criteria. Note: Requires Precertification: Precertification of pembrolizumab (Keytruda) is required of all Aetna participating providers and members...
Medicare Coverage Policy ~ Decisions. Baltimore, MD: CMS; July 19, 2001. Center for Medicare and Medicaid Services (CMS). Medicare to cover treatment for sun-induced skin lesions. Medicare News (Press Release). Baltimore, MD: CMS; July 20, 2001. Chiarello SE. Cryopeeling (extensive ...
Policy Scope of Policy This Clinical Policy Bulletin addresses growth hormone (GH) and growth hormone antagonists for commercial medical plans. For Medicare criteria, seeMedicare Part B Criteria. Note: Requires Precertification: Precertification of Somavert is required of all Aetna participating providers...
Centers for Medicare and Medicaid Services (CMS). Decision memo for infrared therapy devices (CAG-00291N). Medicare Coverage Database. Baltimore, MD: CMS; October 24, 2006. Choi SJ, Cho EH, Jo HM, et al. Clinical utility of far-infrared therapy for improvement of vascular access blood fl...
The American Society of Cataract and Refractive Surgery (ASCRS) and American Society of Ophthalmic Administrators (ASOA) (Stodola, 2013) stated that “According to the ASCRS/ASOA policy, the allowable Medicare reimbursement for cataract surgery does not change according to the surgical methods used. ...
CGS Medicare. Articulating Digit(s) and Prosthetic Hands -- Correct Coding. Durable Medical Equipment Medicare Administrative Contractor (DME MAC) Jurisdiction C. Nashville, TN; CGS Administrators, LLC; December 30, 2011. CGS Medicare. Correct Billing for Upper Limb Prosthesis with L6895 instead of...