Coverage gap This is also called the donut hole. It is the part of the Medicare plan where the member pays for prescription drugs. The plan does not pay. The gap occurs after you reach your initial coverage limit. It lasts until the expenses you pay add up to a certain amount. Covered...
Medicare will generally cover medically necessary supplies, equipment, and nutrients associated with parenteral and enteral nutrition if the coverage requirements for enteral or parenteral nutritional therapy are met under the prosthetic device benefit provision. ...
Aetna dropping some Medicare supplement subscribersPhiladelphia Inquirer
Medical necessity review of infertility drugs by Aetna Specialty Pharmacy Guideline Management may be bypassed for infertility ART drugs that are for use with infertility medical procedures if the infertility procedure has been approved for coverage under the member’s Aetna medical benefit plan. During...
This CPB is being used supplement certain Medicare LCDs and NCDs on spinal surgery (LCD L37848, Lumbar Fusion; LCD L38033, Cervical Disc Arthroplasty; LCD L39773, Cervical Fusion; LCD L39762, Cervical Fusion; LCD L39741, Cervical Fusion; LCD L39788, Cervical Fusion; LCD L39788, Cervical ...
In December 2003, the Centers for Medicare & Medicaid Services (CMS) decided to reverse its initial (July 2002) non-coverage of EMS for the treatment of chronic wounds. Currently, CMS covers the use of ES and electromagnetic stimulation for chronic Stage III and Stage IV pressure ulcers, arte...
NPT or PT for educational reasons is not covered. This testing is usually provided by school systems under applicable state and federal rules. Most benefit plans exclude coverage of educational testing. Please check benefit plan descriptions. In addition, NPT or PT performed for educational reasons ...
Note: For plans that do not exclude coverage of foot orthotics, Aetna covers foot orthotics when the medical necessity criteria below are met. Please check benefit plan descriptions. Foot orthotics are considered medically necessary for members who meet all of the following selection criteria: Member...
Note for Idiopathic Short Stature (ISS): Aetna does not consider idiopathic short stature an illness, disease or injury. Accordingly, coverage would not be available under most plans, which provide coverage only for treatment of illness, injury or disease. If the benefit plan only covers treatment...
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...