Procedures and services on the Aetna Behavioral Health Precertification List Procedures and services that require precertification under the terms of a member’s plan Any organization determination requested by a Medicare Advantage member, appointed representative* or physician for a coverage decision ...
Medicare Get to know your Medicare plan or explore plans with added benefits and services for you. Individuals and families Get helpful guidance to understand your health plan or find quality coverage for you and your family. Medical providers Join the Aetna network, so together we can give...
Precertification of Cetrotide (cetrorelix acetate), ganirelix acetate, Follistim AQ (follitropin beta), Gonal-F (follitropin alfa), Menopur (menotropins), Novarel (chorionic gonadotropin), Pregnyl (chorionic gonadotropin), Ovidrel (choriogonadotropin alfa), and chorionic gonadotropin is required of a...
This Clinical Policy Bulletin addresses botulinum toxin for commercial medical plans. For Medicare criteria, seeMedicare Part B Criteria. Note: Requires Precertification: Precertification of botulinum toxin (Botox [onabotulinumtoxinA]; Daxxify [daxibotulinumtoxinA-lanm], Dysport [abobotulinumtoxinA]; ...
This Clinical Policy Bulletin addresses infliximab for commercial medical plans. For Medicare criteria, seeMedicare Part B Criteria. Note: Requires Precertification: Precertification of an infliximab product (Avsola, Inflectra, Remicade, or Renflexis) is required of all Aetna participating providers and ...
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...
It runs the Medicare program. It also works with states to run the Medicaid program. Certificate of coverage This details the benefits provided by your health plan. It lists what is covered and what is not covered. You will get this document after you sign up for a plan. Certification* ...
This Clinical Policy Bulletin addresses bendamustine for commercial medical plans. For Medicare criteria, seeMedicare Part B Criteria. Note: Requires Precertification: Precertification of bendamustine (Belrapzo, Bendeka, Treanda, Vivimusta, and bendamustine) is required of all Aetna participating provider...
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 in applicable plan desi...
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...