Note: Most Aetna traditional plans cover durable medical equipment (DME) as a standard benefit. Standard Aetna HMO plans do not cover DME without a policy rider. Please check benefit plan descriptions for details. Certain orthopedic casts, braces and splints are covered under HMO plans without the...
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 and members in applicab...
This Clinical Policy Bulletin addresses omalizumab (Xolair) for commercial medical plans. For Medicare criteria, see Medicare Part B Criteria.Note: Requires Precertification:Precertification of omalizumab (Xolair) is required of all Aetna participating providers and members in applicable plan designs. For...
Since surgery to correct a condition of "moon face" which developed as a side effect of cortisone therapy does not meet the exception to the exclusion, it is not covered under Medicare (§1862(a)(10) of the Act). An UpToDate review on “Overview of breast disorders in children and adole...
This Clinical Policy Bulletin addresses vascular endothelial growth factor inhibitors for ocular indications for commercial medical plans. For Medicare criteria, seeMedicare Part B Criteria. Note: Requires Precertification: Precertification of aflibercept [(Eylea), (Eylea HD)], aflibercept-jbvf (Yesafili...
Medicare News (Press Release). Baltimore, MD: CMS; July 20, 2001. Chiarello SE. Cryopeeling (extensive cryosurgery) for treatment of actinic keratoses: An update and comparison. Dermatolog Surg. 2000;26(8):728-732. Cockerell CJ. Histopathology of incipient intraepidermal squamous cell carcinoma...
This policy is based in part upon Medicare DME MAC medical necessity criteria for negative pressure wound therapy (NPWT) pumps. Negative pressure wound therapy is the controlled application of subatmospheric pressure to a wound using an electrical pump to intermittently or continuously convey subatmosph...
However, the Center for Medicare and Medicaid Services has deemed delivery of US via a hands-free unit to be investigational. This investigator examined the effectiveness of tissue heating with a hands-free US technique compared to a hand-held US transducer using the Rich-Mar AutoSound unit. A...
Aetna follows Medicare rules in considering osseointegrated implants, such as implantable BAHAs and temporal bone stimulators, as prosthetics. Medicare considers as prosthetics "osseointegrated implants, i.e., devices implanted in the skull that replace the function of the middle ear and provide mechan...
Aetna follows Medicare rules in considering cochlear implants and auditory brainstem implants as prosthetics. Medicare considers as prosthetics "[c]ochlear implants and auditory brainstem implants, i.e., devices that replace the function of cochlear structures or auditory nerve and provide electrical ener...