For the treatment of PsA, member has a contraindication, intolerance or ineffective response to all of the following available equivalent alternative targeted immune modulators (one-month trial each): Simponi Aria, Stelara, and Avsola or Inflectra Chronic Severe Plaque Psoriasis For the treatment of c...
a questionnaire completed by a video analyst who reviews parent/caregiver recorded videos of the child, and a healthcare provider questionnaire completed by a physician during child and parent/caregiver interaction via a healthcare provider portal. ...
Aetna considers an implantable infusion pump medically necessary when used to intrathecally administer anti-spasmodic drugs (e.g., baclofen) to treat chronic intractable spasticity in persons who have proven unresponsive to less invasive medical therapy as determined by the following criteria: Member ha...
According to the Society for Maternal-Fetal Medicine (SMFM, 2013), when a choroid plexus cyst is identified, the presence of structural malformations and other sonographic markers of aneuploidy should be assessed with a detailed fetal anatomic survey performed by an experienced provider. Detailed exami...
Vescovi and Nammour (2010) stated that BRONJ is an area of uncovered bone in the maxillo-facial region that did not heal within 8 weeks after identification by health care provider, in a patient who was receiving or had been exposed to BP therapy (BPT) without previous radiation therapy to...
The provider will be notified of the coverage decision after review of all pertinent data. Diagnostic Testing Aetna considers the following medically necessary for diagnostic testing for TMJ/TMD using the following modalities: Examination including a history, physical examination, muscle testing, range ...