Aetna Medical Policy Updates – March 2019

Click here to view the Aetna Medical Policy Updates »

March 2019 Aetna Medical Policy Updates:

• Abdominal Aortic Aneurysm Screening
• Acoustic Heart Sound Recording and Computer Analysis
• Allograft Transplants of the Extremities
• Androgens and Anabolic Steroids
• Antineoplaston Therapy and Sodium Phenylbutyrate
• Antiprothrombin Antibody Testing
• Asfotase alfa (Strensiq)
• Athletic Pubalgia Surgery
• Attention Deficit/Hyperactivity Disorder
• Auditory Processing Disorder (APD)
• Autotransfusers
• Axial Lumbar Interbody Fusion (AxiaLIF)
• Benign Skin Lesion Removal
• Blood Product Injections for Selected Indications
• Body Surface Potential Mapping
• BRCA Testing, Prophylactic Mastectomy, and Prophylactic Oophorectomy
• Breast Biopsy Procedures
• Breast Transillumination, Electrical Impedance Scanning (EIS), and Elastography
• Brentuximab (Adcetris)
• Bronchial Thermoplasty
• Broth Culture Testing for Interstitial Cystitis
• Cabazitaxel (Jevtana)
• Cardiac Devices and Procedures for Occlusion of the Left Atrial Appendage
• Cardiovascular Disease Risk Tests
• Chelation Therapy
• Chemical Aversive Conditioning for Alcoholism
• Cholecystokinin Cholescintigraphy
• Chronic Fatigue Syndrome
• Chronic Pain Programs
• Cognitive Rehabilitation
• Colorectal Cancer Screening
• Complex Regional Pain Syndrome (CRPS) / Reflex Sympathetic Dystrophy (RSD)
• Convection-Enhanced Intraparenchymal Delivery of Drugs to the Brain
• Corneal Pachymetry
• Cryoanalgesia and Therapeutic Cold
• Diphtheria, Tetanus, and Pertussis Vaccines
• Discography
• Distraction Osteosynthesis
• Donor Lymphocyte Infusion
• Dry Eyes
• Dry Hydrotherapy (Hydromassage, Aquamassage, Water Massage)
• Early Intervention Programs – Medical Clinical Policy Bulletins | Aetna
• Electromagnetic Navigation-guided Bronchoscopy
• Elotuzumab (Empliciti)
• Endoscopic Ultrasonography
• Enfuvirtide (Fuzeon)
• Epiretinal Radiation Therapy
• Eteplirsen (Exondys 51)
• Evoked Potential Studies
• Extended Ophthalmoscopy
• Eye Prosthesis
• Eyelid Surgery
• Facial Prostheses, External
• Foot Orthotics
• Gastric Pacing and Gastric Electrical Stimulation
• Gastrointestinal Manometry
• Genetic Testing
• Glaucoma Testing
• Graves’ Ophthalmopathy Treatments
• Grid Monitoring and Intraoperative Electroencephalography
• Growth Hormone (GH) and Growth Hormone Antagonists
• Heart-Lung Transplantation
• Hematopoietic Cell Transplantation for Chronic Myelogenous Leukemia
• Hematopoietic Cell Transplantation for Ovarian Cancer
• Hematopoietic Cell Transplantation for Selected Leukemias
• Hematopoietic Cell Transplantation for Testicular Cancer
• Hematopoietic Cell Transplantation for Thalassemia Major and Sickle Cell Anemia
• High-Frequency Pulsed Electromagnetic Stimulation
• Hippotherapy
• Histamine Desensitization Therapy for Intractable Headaches
• Home Health Aides
• Hyperbaric Oxygen Therapy (HBOT)
• Hyperthermia in Cancer Therapy
• Hypertrophic Scars and Keloids
• Indirect Measurement of Left Ventricular Filling Pressure (LVFP): The VeriCor System
• Infertility
• Infliximab – Medical Clinical Policy Bulletins | Aetna
• Influenza Rapid Diagnostic Tests
• Infusion Pumps
• Intermittent Intravenous Insulin Therapy
• Intestinal Transplantation
• Intra-oral Appliances for Headaches and Trigeminal Neuralgia
• Ipilimumab (Yervoy)
• Laser Photocoagulation of Drusen
• Lead Testing
• Levator Syndrome Treatments
• Levoleucovorin (Fusilev)
• Lyme Disease and other Tick-Borne Diseases
• Lysosomal Storage Disorders Treatments
• Magnetic Resonance Cholangiopancreatography
• Magnetic Resonance Imaging (MRI) of the Extremities
• Mechanical Stretching Devices for Contracture and Joint Stiffness – Medical Clinical Policy Bulletins | Aetna
• Menaflex
• Metabolic and Environmental Profiling and Imaging for Kidney Stone Risk
• Multiple Sclerosis
• Natalizumab (Tysabri)
• Necitumumab (Portrazza)
• Negative Pressure Wound Therapy
• Neuralgia Inducing Cavitational Osteonecrosis (NICO) and Ultrasonograph Bone Densitometer to Detect NICO
• Neuropsychological and Psychological Testing
• Noncontact Normothermic/Nonthermal Wound Therapy
• Non-myeloablative Hematopoietic Cell Transplantation (Mini-Allograft / Reduced Intensity Conditioning Transplant)
• Ocular Photoscreening
• Olaratumab (Lartruvo)
• Oprelvekin (Neumega)
• Osteochondral Autografts (Mosaicplasty, OATS)
• Ostomy Supplies
• Pancreas Transplantation Alone (PTA) and Islet Cell Transplantation
• Paralytic Lagophthalmos Treatments
• Parkinson’s Disease
• Pembrolizumab (Keytruda)
• Peripheral Ultrafiltration for Acute Decompensated Heart Failure
• Phototherapy and Photochemotherapy (PUVA) for Skin Conditions
• Phototherapy for Psychiatric Disorders
• Prolotherapy
• Prostate Saturation Biopsy
• Pulmonary Hypertension Treatments and Selected Indications of Prostanoids
• Quantitative Sensory Testing Methods
• RenalVysion
• Reslizumab (Cinqair)
• Rhinometry and Rhinomanometry
• Rituximab (Rituxan)
• Safety Items
• Selected Aortic Valve Procedures: Ross Pulmonary Autograft and Aortic Valve-Sparing Re-implantation – Medical Clinical Policy Bulletins | Aetna
• Signal-Averaged Electrocardiography (SAECG)
• Smallpox Vaccine
• Spinal Ultrasound
• Stereolithography
• Subtalar Implant for Foot Deformity
• Suit Therapy
• Suprachoroidal Injection of Pharmacologic Agents
• Surface Scanning and Macro Electromyography
• Thermal Perfusion Probe for Monitoring Regional Cerebral Blood Flow
• Tinnitus Treatments
• Total-Body CT Screening
• Tourette’s Syndrome
• Trabectedin (Yondelis)
• Transanal Endoscopic Microsurgery for Rectal Cancer
• Transcranial Magnetic Stimulation and Cranial Electrical Stimulation
• Transperineal Placement of Biodegradeable Material (SpaceOAR) for Prostate Cancer – Medical Clinical Policy Bulletins | Aetna
• Tubal Sterilization
• Tuberculosis Testing
• Tumor Chemoresistance Assays
• Tumor Markers
• Tumor Scintigraphy
• Ultrasound for Pregnancy
• Ultrasound Therapy for Wound Healing
• Upper Gastrointestinal Endoscopy
• Uterine Nerve Ablation (UNA) and Presacral Neurectomy (PSN)
• Vagus Nerve Stimulation
• Viscosupplementation
• Vitiligo
• Wheelchairs and Power Operated Vehicles (Scooters)
• Wound Care

Click here to view the Aetna Medical Policy Updates »

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