This Clinical Policy Bulletin addresses gonadotropin-releasing hormone analogs and antagonists for commercial medical plans. For Medicare criteria, seeMedicare Part B Criteria. Note: Requires Precertification: For the prostate cancer indication only, precertification of gonadotropin-releasing hormone products (...
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...
A major draw for Medicare Advantage is the supplemental benefit offerings that these private plans can provide, ranging from dental and vision coverage to pharmacy benefits to programs targeting the social determinants of health. And while those benefits have largely grown with the program, payment ra...
Aetna plans exclude coverage of cosmetic surgery and procedures that are not medically necessary, but generally provide coverage when the surgery or procedure is needed to improve the functioning of a body part or otherwise medically necessary even if the surgery or procedure also improves or changes...
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...
This Clinical Policy Bulletin addresses the following tocilizumab products for commercial medical plans. For Medicare criteria, see Medicare Part B Criteria.tocilizumab (Actemra) tocilizumab-aazq (Tyenne) tocilizumab-bavi (Tofidence)Note: Requires Precertification:...
S0119 Ondansetron, oral, 4 mg (for circumstances falling under the Medicare statute, use HCPCS Q code) ICD-hyphen10 codes covered if selection criteria are met: G93.32 Myalgic encephalomyelitis/chronic fatigue syndrome R53.81 -hyphen R53.83 Other malaise and fatigueBack...
Aetna's policy on parenteral and enteral nutrition is similar to Medicare policy. Medicare provides reimbursement under the part-B prosthetic-device benefit for parenteral and enteral nutrition. Consistent with its policy of covering supplies necessary for use of prosthetics, Medicare will generally cover...
Note: Except for Medicare plans and where coverage is mandated by state law, generally coverage for diabetic supplies would be provided under a pharmacy rider and not as part of medical coverage. Certain diabetic supplies may also be covered under the medical plan if no pharmacy or diabetic supp...
For Medicare Part B plans, call (866) 503-0857 or fax (844) 268-7263.Hepatitis B Immune GlobulinCriteria for Initial Approval Aetna considers hepatitis B immune globulin medically necessary for members who have had contact with an individual diagnosed with hepatitis B virus (HBV). Risk groups ...