Clinical coverage policies · 2026
Aetna coverage criteria
Aetna's clinical coverage criteria by procedure — who qualifies, the prior-authorization rules, the documentation needed, and what's excluded. Every policy is sourced from Aetna's own published clinical-policy documents.
108 source-backed Aetna policies · Aetna prior-authorization requirements →
- AcupunctureConfirm PA
CPB 0135
- Allergy Testing and ImmunotherapyConfirm PA
CPB 0038
- Back Pain - Invasive ProceduresConfirm PA
CPB 0016
- Benign Prostatic HyperplasiaConfirm PA
CPB 0079
- BiofeedbackConfirm PA
CPB 0132
- Bone Growth StimulatorsConfirm PA
CPB 0343
- Bone Mass MeasurementsConfirm PA
CPB 0134
- Botulinum ToxinConfirm PA
CPB 0113
- BrachytherapyConfirm PA
CPB 0371
- BRCA Testing, Prophylactic Mastectomy, Prophylactic OophorectomyConfirm PA
CPB 0227
- Breast MRIConfirm PA
CPB 0105
- Breast Reconstructive SurgeryConfirm PA
CPB 0185
- Breast Reduction SurgeryConfirm PA
CPB 0017
- Capsule EndoscopyConfirm PA
CPB 0588
- Cardiac Catheter AblationConfirm PA
CPB 0165
- Cardiac CT and Calcium ScoringConfirm PA
CPB 0228
- Cardiac Event MonitorsConfirm PA
CPB 0073
- Cardiac MRIConfirm PA
CPB 0520
- Cardiac RehabilitationConfirm PA
CPB 0021
- Cardiac Resynchronization Therapy (Biventricular Pacing)Confirm PA
CPB 0610
- Cardioverter-DefibrillatorsConfirm PA
CPB 0585
- Cataract SurgeryConfirm PA
CPB 0508
- Cervical Cancer ScreeningConfirm PA
CPB 0443
- Chronic Pain ProgramsConfirm PA
CPB 0237
- Cochlear ImplantsConfirm PA
CPB 0013
- Cold Laser and High-Power Laser TherapiesConfirm PA
CPB 0363
- Color-Flow Doppler EchocardiographyConfirm PA
CPB 0008
- Colorectal Cancer ScreeningConfirm PA
CPB 0516
- CRPS/RSD TreatmentsConfirm PA
CPB 0447
- Deep Brain StimulationConfirm PA
CPB 0208
- Diabetes Tests, Programs and SuppliesConfirm PA
CPB 0070
- Drug-Eluting StentsConfirm PA
CPB 0621
- Electrical Stimulation for Pain (TENS/PENS)Confirm PA
CPB 0011
- Electroconvulsive Therapy (ECT)Confirm PA
CPB 0445
- EMDRConfirm PA
CPB 0583
- Endometrial AblationConfirm PA
CPB 0091
- Endoscopic UltrasonographyConfirm PA
CPB 0446
- Endovascular Repair of Aortic AneurysmsConfirm PA
CPB 0651
- Esophageal pH MonitoringConfirm PA
CPB 0667
- Fibroid TreatmentConfirm PA
CPB 0304
- Gender Affirming SurgeryConfirm PA
CPB 0615
- Genetic TestingConfirm PA
CPB 0140
- Glaucoma SurgeryConfirm PA
CPB 0484
- Heart TransplantationConfirm PA
CPB 0586
- Hip Arthroplasty (Total Hip Implants)Confirm PA
CPB 0287
- Hyperbaric Oxygen Therapy (HBOT)Confirm PA
CPB 0172
- Hyperthermia in Cancer TherapyConfirm PA
CPB 0278
- Implantable Hormone PelletsConfirm PA
CPB 0345
- InfertilityConfirm PA
CPB 0327
- Infusion PumpsConfirm PA
CPB 0161
- Intensity Modulated Radiation Therapy (IMRT)Confirm PA
CPB 0590
- Intravenous Immunoglobulins (IVIG)Confirm PA
CPB 0206
- Invasive Prenatal Diagnosis of Genetic DiseasesConfirm PA
CPB 0358
- Kidney TransplantationConfirm PA
CPB 0493
- Knee ArthroplastyConfirm PA
CPB 0660
- Knee ArthroscopyConfirm PA
CPB 0673
- Left Atrial Appendage Occlusion DevicesConfirm PA
CPB 0791
- Liver TransplantationConfirm PA
CPB 0596
- Lower Limb ProsthesesConfirm PA
CPB 0578
- Lung Cancer ScreeningConfirm PA
CPB 0380
- Lymphedema TreatmentsConfirm PA
CPB 0069
- MammographyConfirm PA
CPB 0584
- Mohs Micrographic SurgeryConfirm PA
CPB 0383
- MRA and MRVConfirm PA
CPB 0094
- MRI and CT of the SpineConfirm PA
CPB 0236
- MRI of the ExtremitiesConfirm PA
CPB 0171
- Multiple SclerosisConfirm PA
CPB 0264
- Multiple Sleep Latency Test (MSLT)Confirm PA
CPB 0330
- NebulizersConfirm PA
CPB 0065
- Negative Pressure Wound TherapyConfirm PA
CPB 0334
- Nerve Conduction StudiesConfirm PA
CPB 0502
- Neuropsychological and Psychological TestingConfirm PA
CPB 0158
- Noninvasive Positive Pressure Ventilation (CPAP/BiPAP)Confirm PA
CPB 0452
- Obesity SurgeryConfirm PA
CPB 0157
- Obstructive Sleep Apnea in AdultsConfirm PA
CPB 0004
- Obstructive Sleep Apnea in ChildrenConfirm PA
CPB 0752
- Occupational TherapyConfirm PA
CPB 0250
- Optic Nerve and Retinal ImagingConfirm PA
CPB 0344
- OxygenConfirm PA
CPB 0002
- Parkinson's DiseaseConfirm PA
CPB 0307
- Pharmacogenetic TestingConfirm PA
CPB 0715
- Physical TherapyConfirm PA
CPB 0325
- Positron Emission Tomography (PET)Confirm PA
CPB 0071
- Prostate Cancer ScreeningConfirm PA
CPB 0521
- Proton Beam and Neutron Beam RadiotherapyConfirm PA
CPB 0270
- Pulmonary RehabilitationConfirm PA
CPB 0032
- Selective Nerve Root BlocksConfirm PA
CPB 0722
- Septoplasty and RhinoplastyConfirm PA
CPB 0005
- Shoulder Arthroplasty and ArthrodesisConfirm PA
CPB 0837
- Sinus SurgeriesConfirm PA
CPB 0937
- SPECTConfirm PA
CPB 0376
- Speech TherapyConfirm PA
CPB 0243
- Spinal Cord Stimulation (Dorsal Column Stimulation)Confirm PA
CPB 0194
- Spinal Surgery: Laminectomy and FusionConfirm PA
CPB 0743
- Stereotactic RadiosurgeryConfirm PA
CPB 0083
- Total Ankle ArthroplastyConfirm PA
CPB 0645
- Transcranial Magnetic Stimulation (TMS)Confirm PA
CPB 0469
- Tumor MarkersConfirm PA
CPB 0352
- Upper Gastrointestinal EndoscopyConfirm PA
CPB 0738
- Urinary IncontinenceConfirm PA
CPB 0223
- Vagus Nerve StimulationConfirm PA
CPB 0191
- Varicose VeinsConfirm PA
CPB 0050
- Vascular Endothelial Growth Factor Inhibitors for Ocular IndicationsConfirm PA
CPB 0701
- Ventricular Assist DevicesConfirm PA
CPB 0654
- Viscosupplementation for OsteoarthritisConfirm PA
CPB 0179
- Weight Reduction ProgramsConfirm PA
CPB 0039
- WheelchairsConfirm PA
CPB 0271
- Wound Care (Skin and Soft Tissue Substitutes)Confirm PA
CPB 0244