Aetna Medically Necessary

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Medical Clinical Policy Bulletins - Aetna

https://www.aetna.com/health-care-professionals/clinical-policy-bulletins/medical-clinical-policy-bulletins.html

Aetna's conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna). Your benefits plan determines coverage. Some plans exclude coverage for …

Precertification – Health Care Professionals …

https://www.aetna.com/health-care-professionals/precertification.html

Aetna's conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be …

Physical Therapy - Medical Clinical Policy Bulletins | Aetna

https://www.aetna.com/cpb/medical/data/300_399/0325.html

Aetna considers home-based physical therapy medically necessary in selected cases based upon the member's needs (i.e., the member must be homebound). This may be …

Contact Lenses and Eyeglasses - Medical Clinical Policy …

https://www.aetna.com/cpb/medical/data/100_199/0126.html

Aetna considers the following contact lenses for myopia management medically necessary when criteria are met. Note: Aetna standard medical benefit plans exclude …

Cosmetic Surgery and Procedures - Medical Clinical …

https://www.aetna.com/cpb/medical/data/1_99/0031.html

Considered medically necessary when criteria are met, as set forth in CPB 0211 - Abdominoplasty, Suction Lipectomy, and Ventral Hernia Repair. Implantation and …

Allergy and Hypersensitivity - Medical Clinical Policy …

https://www.aetna.com/cpb/medical/data/1_99/0038.html

Aetna considers the following allergy tests medically necessary: Epicutaneous (scratch, prick or puncture when immunoglobulin E (IgE)-mediated reactions occur to any of the …

eviCore health care medical necessity requirement | Aetna

https://qawww.aetna.com/health-care-professionals/newsletters-news/office-link-updates-december-2021/important-reminders-december-2021/evicore-healthcare-site-of-care-medical-necessity-requirement.html

An advanced imaging procedure at a hospital outpatient site is considered medically necessary when cases involve certain factors. Examples are those where: the individual …

Medical Necessity Definition in Health Insurance

https://www.verywellhealth.com/medical-necessity-1738748

Medical necessity refers to a decision by your health plan that your treatment, test, or procedure is necessary to maintain or restore your health or to treat a …

Dental Services and Oral and Maxillofacial Surgery: …

https://www.aetna.com/cpb/medical/data/1_99/0082.html

To be considered medically necessary, orthodontic services must be needed to treat, correct or ameliorate a medical defect or condition, and an essential part of an …

Skilled Home Private Duty Nursing Care - Medical …

https://www.aetna.com/cpb/medical/data/100_199/0136.html

One day of medically fragile daycare is considered equivalent to 8 hours of private duty nursing. If the member who is participating in such a program can not attend medically …

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