Aetna · Clinical coverage policy

Aetna Colorectal Cancer Screening coverage criteria

Aetna CPB 0516 covers colorectal cancer screening for average-risk members aged 45 and older using any one accepted modality at set intervals (colonoscopy every 10 years, FOBT yearly, stool DNA every 1-3 years, CT colonography/DCBE/sigmoidoscopy every 5 years), with more frequent high-risk testing and surveillance for those with family history, hereditary syndromes, IBD, prior adenomas, or prior colorectal cancer. Routine screening is not medically necessary at age 85 or older unless life expectancy is at least 10 years, and a long list of newer/blood-based/molecular and other tests (plus anal Pap/HPV screening, drug-coated balloon, and the full-thickness resection device) are considered experimental, investigational, or unproven.

Policy CPB 0516 · Effective · Verify against the current Aetna policy before submitting — view source policy.

Payer

Aetna

Policy

CPB 0516

Prior auth

Confirm

Effective

January 1, 2026

This page reflects the coverage criteria captured from Aetna policy CPB 0516 and may not include every criterion, exception, or code — verify the complete bulletin before submitting.

What this means for the claim

The covered path, the next step to get it approved, and the specific way it denies — built only from this policy.

When does Aetna cover Colorectal Cancer Screening (CPT 45378), and what gets it denied?

Path
Aetna CPB 0516 covers colorectal cancer screening for average-risk members aged 45 and older using any one accepted modality at set intervals (colonoscopy every 10 years, FOBT yearly, stool DNA every 1-3 years, CT colonography/DCBE/sigmoidoscopy every 5 years), with more frequent high-risk testing and surveillance for those with family history, hereditary syndromes, IBD, prior adenomas, or prior colorectal cancer. Routine screening is not medically necessary at age 85 or older unless life expectancy is at least 10 years, and a long list of newer/blood-based/molecular and other tests (plus anal Pap/HPV screening, drug-coated balloon, and the full-thickness resection device) are considered experimental, investigational, or unproven. Coverage criteria include: Routine screening, average-risk members aged 45 years and older when physician-recommended — covered with ANY ONE of the following modalities at the stated interval: colonoscopy every 10 years; OR CT colonography (virtual colonoscopy) every 5 years; OR double-contrast barium enema (DCBE) every 5 years; OR immunohistochemical or guaiac-based fecal occult blood testing (FOBT) every year; OR sigmoidoscopy every 5 years; OR sigmoidoscopy every 5 years WITH annual immunohistochemical or guaiac-based FOBT; OR stool DNA test (FIT-DNA, e.g., Cologuard, Cologuard Plus) every 1 to 3 years; Average-risk colonoscopy is medically necessary every 10 years; Average-risk CT colonography (virtual colonoscopy) is medically necessary every 5 years; Average-risk double-contrast barium enema (DCBE) is medically necessary every 5 years; Average-risk immunohistochemical or guaiac-based fecal occult blood testing (FOBT) is medically necessary every year (annually); Average-risk sigmoidoscopy is medically necessary every 5 years; Average-risk sigmoidoscopy every 5 years combined with annual immunohistochemical or guaiac-based FOBT is medically necessary; Average-risk stool DNA testing (FIT-DNA, e.g., Cologuard / Cologuard Plus) is medically necessary every 1 to 3 years; High-risk testing with colonoscopy, sigmoidoscopy, or DCBE is medically necessary as frequently as every 2 years for members with ANY ONE of the listed high-risk factors; High-risk: first-degree relative with colorectal cancer or adenomatous polyps — screening medically necessary beginning at age 40 years, OR 10 years younger than the earliest diagnosis in the family, whichever comes first; High-risk: family history of Familial Adenomatous Polyposis (FAP) — screening medically necessary beginning at puberty; High-risk: family history of Hereditary Non-Polyposis Colorectal Cancer (HNPCC / Lynch syndrome) — screening medically necessary beginning at age 20 years; High-risk: family history of MYH-associated polyposis in siblings — screening medically necessary beginning at age 25 years; High-risk: diagnosis of Cowden syndrome — screening medically necessary beginning at age 35 years; Annual FOBT, alone or in conjunction with sigmoidoscopy, is medically necessary for testing members with any of the above high-risk factors for colorectal cancer; Surveillance covered for members meeting ANY ONE of the following: inflammatory bowel disease (IBD), personal history of adenomatous polyps, or personal history of colorectal cancer; Surveillance: inflammatory bowel disease (IBD), including ulcerative colitis or Crohn's disease — colorectal cancer surveillance with colonoscopy, flexible sigmoidoscopy, or DCBE is medically necessary as frequently as every year; Surveillance: personal history of adenomatous polyps — surveillance is medically necessary as frequently as every 2 years; Surveillance: personal history of colorectal cancer — surveillance is medically necessary as frequently as every year; Annual FOBT, alone or in conjunction with sigmoidoscopy, is medically necessary for surveillance of colorectal cancer; Diagnostic testing with FOBT, colonoscopy, sigmoidoscopy, and/or DCBE is medically necessary for evaluation of members with signs or symptoms of colorectal cancer or other gastrointestinal diseases; Biopsy of lower GI tract — microscopic colitis: 8 or more biopsies medically necessary in persons with symptoms suggestive of microscopic colitis (e.g., diarrhea and/or functional abdominal pain), with 2 or more taken from each of the ascending, transverse, descending, and sigmoid colon; Biopsy of lower GI tract — inflammatory bowel disease diagnosis: 2 or more biopsies from 5 different locations, including the ileum and rectum; Biopsy of lower GI tract — inflammatory bowel disease screening for dysplasia: targeted biopsies PLUS, for pancolitis or segmental colitis, biopsies from the 4 quadrants every 10 cm; Biopsy of lower GI tract — pouchitis: multiple biopsies from the pouch and afferent loop; Biopsy of lower GI tract — colonic polyps: biopsies of polyps that cannot be removed; Biopsy of lower GI tract — acute graft-versus-host disease: medically necessary with EITHER flexible sigmoidoscopy (4 or more biopsies from the rectum/sigmoid AND 4 or more biopsies from the left colon) OR ileocolonoscopy (4 or more biopsies from the terminal ileum, ascending colon, transverse colon, descending colon, and rectum/sigmoid colon). Applies to 13 codes: 45378, 45380, 45381, 45382, 45384, 45385, 45386, 45388, 45390, 82270, G0104, G0105, G0121.
Action
Confirm prior-authorization status with Aetna before scheduling — it is code- and plan-specific, and this policy is not an exact authorization source. Documentation: Providers may be required to submit photographs of mucosal abnormalities seen on colonoscopy.
Trap
Policy exclusions and limitations: Routine colorectal cancer screening for members 85 years of age or older is considered not medically necessary UNLESS life expectancy is greater than or equal to 10 years; Experimental, investigational, or unproven: Artificial intelligence-aided colonoscopy (including computer-aided colonoscopy); Experimental, investigational, or unproven: Blood-based protein biomarkers (e.g., BeScreened-CRC, Beacon Biomedical, Inc.); Experimental, investigational, or unproven: Capsule endoscopy; Experimental, investigational, or unproven: CD3 immuno-staining; Experimental, investigational, or unproven: Chromoendoscopy or narrow-band imaging optical colonoscopy; Experimental, investigational, or unproven: Colon AiQ; Experimental, investigational, or unproven: Fecal volatile organic compounds; Experimental, investigational, or unproven: Full-spectrum endoscopy (FUSE) colonoscopy; Experimental, investigational, or unproven: Guardant Shield Test; Experimental, investigational, or unproven: Methylated Septin 9 (ColoVantage, Epi proColon); Experimental, investigational, or unproven: MicroRNAs; Experimental, investigational, or unproven: Performance of multiple screening strategies simultaneously in the same individual (e.g., virtual colonoscopy screening every 5 years plus stool DNA testing every 3 years); Experimental, investigational, or unproven: Plasma/serum biomarkers (C-reactive protein, complement C3a anaphylatoxin, plasma GATA5 and SFRP2 methylation, serum CD26 [sCD26], serum matrix metalloproteinase-7 [MMP-7], and tissue inhibitor of metalloproteinases [TIMP-1]); Experimental, investigational, or unproven: PolypDx (Atlantic Diagnostic Laboratories, LLC, Metabolomic Technologies Inc.); Experimental, investigational, or unproven: Screening beginning at earlier than standard recommended ages for persons at increased risk due to smoking or obesity; Experimental, investigational, or unproven: SimpliPro Colon Test; Experimental, investigational, or unproven: Stool-based protein biomarkers; Experimental, investigational, or unproven: Stool molecular genetic tests other than Cologuard (e.g., ColoCaller Test, ColoSense multi-target stool RNA test, ColoSure, PreGen-Plus); Experimental, investigational, or unproven: Whole-blood DNA methylation markers; Experimental, investigational, or unproven: Screening for anal cytological abnormalities (anal Pap smear) or for anal human papillomavirus (HPV) infection — because of the lack of evidence that such screening improves clinical outcomes; Experimental, investigational, or unproven: Drug-coated balloon for the treatment of colonic strictures; Experimental, investigational, or unproven: Full-thickness resection device (FTRD) for endoscopic resection of appendiceal polyp. Claims may be denied when the requested service falls under these. Some of these are conditional (note the stated exceptions) — confirm specifics against the bulletin.

Source: Aetna CPB 0516 — Colorectal Cancer Screening

Coverage criteria

  • Routine screening, average-risk members aged 45 years and older when physician-recommended — covered with ANY ONE of the following modalities at the stated interval: colonoscopy every 10 years; OR CT colonography (virtual colonoscopy) every 5 years; OR double-contrast barium enema (DCBE) every 5 years; OR immunohistochemical or guaiac-based fecal occult blood testing (FOBT) every year; OR sigmoidoscopy every 5 years; OR sigmoidoscopy every 5 years WITH annual immunohistochemical or guaiac-based FOBT; OR stool DNA test (FIT-DNA, e.g., Cologuard, Cologuard Plus) every 1 to 3 years
  • Average-risk colonoscopy is medically necessary every 10 years
  • Average-risk CT colonography (virtual colonoscopy) is medically necessary every 5 years
  • Average-risk double-contrast barium enema (DCBE) is medically necessary every 5 years
  • Average-risk immunohistochemical or guaiac-based fecal occult blood testing (FOBT) is medically necessary every year (annually)
  • Average-risk sigmoidoscopy is medically necessary every 5 years
  • Average-risk sigmoidoscopy every 5 years combined with annual immunohistochemical or guaiac-based FOBT is medically necessary
  • Average-risk stool DNA testing (FIT-DNA, e.g., Cologuard / Cologuard Plus) is medically necessary every 1 to 3 years
  • High-risk testing with colonoscopy, sigmoidoscopy, or DCBE is medically necessary as frequently as every 2 years for members with ANY ONE of the listed high-risk factors
  • High-risk: first-degree relative with colorectal cancer or adenomatous polyps — screening medically necessary beginning at age 40 years, OR 10 years younger than the earliest diagnosis in the family, whichever comes first
  • High-risk: family history of Familial Adenomatous Polyposis (FAP) — screening medically necessary beginning at puberty
  • High-risk: family history of Hereditary Non-Polyposis Colorectal Cancer (HNPCC / Lynch syndrome) — screening medically necessary beginning at age 20 years
  • High-risk: family history of MYH-associated polyposis in siblings — screening medically necessary beginning at age 25 years
  • High-risk: diagnosis of Cowden syndrome — screening medically necessary beginning at age 35 years
  • Annual FOBT, alone or in conjunction with sigmoidoscopy, is medically necessary for testing members with any of the above high-risk factors for colorectal cancer
  • Surveillance covered for members meeting ANY ONE of the following: inflammatory bowel disease (IBD), personal history of adenomatous polyps, or personal history of colorectal cancer
  • Surveillance: inflammatory bowel disease (IBD), including ulcerative colitis or Crohn's disease — colorectal cancer surveillance with colonoscopy, flexible sigmoidoscopy, or DCBE is medically necessary as frequently as every year
  • Surveillance: personal history of adenomatous polyps — surveillance is medically necessary as frequently as every 2 years
  • Surveillance: personal history of colorectal cancer — surveillance is medically necessary as frequently as every year
  • Annual FOBT, alone or in conjunction with sigmoidoscopy, is medically necessary for surveillance of colorectal cancer
  • Diagnostic testing with FOBT, colonoscopy, sigmoidoscopy, and/or DCBE is medically necessary for evaluation of members with signs or symptoms of colorectal cancer or other gastrointestinal diseases
  • Biopsy of lower GI tract — microscopic colitis: 8 or more biopsies medically necessary in persons with symptoms suggestive of microscopic colitis (e.g., diarrhea and/or functional abdominal pain), with 2 or more taken from each of the ascending, transverse, descending, and sigmoid colon
  • Biopsy of lower GI tract — inflammatory bowel disease diagnosis: 2 or more biopsies from 5 different locations, including the ileum and rectum
  • Biopsy of lower GI tract — inflammatory bowel disease screening for dysplasia: targeted biopsies PLUS, for pancolitis or segmental colitis, biopsies from the 4 quadrants every 10 cm
  • Biopsy of lower GI tract — pouchitis: multiple biopsies from the pouch and afferent loop
  • Biopsy of lower GI tract — colonic polyps: biopsies of polyps that cannot be removed
  • Biopsy of lower GI tract — acute graft-versus-host disease: medically necessary with EITHER flexible sigmoidoscopy (4 or more biopsies from the rectum/sigmoid AND 4 or more biopsies from the left colon) OR ileocolonoscopy (4 or more biopsies from the terminal ileum, ascending colon, transverse colon, descending colon, and rectum/sigmoid colon)

Covered codes

Codes listed in this Aetna policy. Check each one's prior-authorization verdict and Medicare rate:

Documentation required

  • Providers may be required to submit photographs of mucosal abnormalities seen on colonoscopy

Frequently asked questions

When does Aetna cover Colorectal Cancer Screening (CPT 45378), and what gets it denied?
Aetna CPB 0516 covers colorectal cancer screening for average-risk members aged 45 and older using any one accepted modality at set intervals (colonoscopy every 10 years, FOBT yearly, stool DNA every 1-3 years, CT colonography/DCBE/sigmoidoscopy every 5 years), with more frequent high-risk testing and surveillance for those with family history, hereditary syndromes, IBD, prior adenomas, or prior colorectal cancer. Routine screening is not medically necessary at age 85 or older unless life expectancy is at least 10 years, and a long list of newer/blood-based/molecular and other tests (plus anal Pap/HPV screening, drug-coated balloon, and the full-thickness resection device) are considered experimental, investigational, or unproven. Coverage criteria include: Routine screening, average-risk members aged 45 years and older when physician-recommended — covered with ANY ONE of the following modalities at the stated interval: colonoscopy every 10 years; OR CT colonography (virtual colonoscopy) every 5 years; OR double-contrast barium enema (DCBE) every 5 years; OR immunohistochemical or guaiac-based fecal occult blood testing (FOBT) every year; OR sigmoidoscopy every 5 years; OR sigmoidoscopy every 5 years WITH annual immunohistochemical or guaiac-based FOBT; OR stool DNA test (FIT-DNA, e.g., Cologuard, Cologuard Plus) every 1 to 3 years; Average-risk colonoscopy is medically necessary every 10 years; Average-risk CT colonography (virtual colonoscopy) is medically necessary every 5 years; Average-risk double-contrast barium enema (DCBE) is medically necessary every 5 years; Average-risk immunohistochemical or guaiac-based fecal occult blood testing (FOBT) is medically necessary every year (annually); Average-risk sigmoidoscopy is medically necessary every 5 years; Average-risk sigmoidoscopy every 5 years combined with annual immunohistochemical or guaiac-based FOBT is medically necessary; Average-risk stool DNA testing (FIT-DNA, e.g., Cologuard / Cologuard Plus) is medically necessary every 1 to 3 years; High-risk testing with colonoscopy, sigmoidoscopy, or DCBE is medically necessary as frequently as every 2 years for members with ANY ONE of the listed high-risk factors; High-risk: first-degree relative with colorectal cancer or adenomatous polyps — screening medically necessary beginning at age 40 years, OR 10 years younger than the earliest diagnosis in the family, whichever comes first; High-risk: family history of Familial Adenomatous Polyposis (FAP) — screening medically necessary beginning at puberty; High-risk: family history of Hereditary Non-Polyposis Colorectal Cancer (HNPCC / Lynch syndrome) — screening medically necessary beginning at age 20 years; High-risk: family history of MYH-associated polyposis in siblings — screening medically necessary beginning at age 25 years; High-risk: diagnosis of Cowden syndrome — screening medically necessary beginning at age 35 years; Annual FOBT, alone or in conjunction with sigmoidoscopy, is medically necessary for testing members with any of the above high-risk factors for colorectal cancer; Surveillance covered for members meeting ANY ONE of the following: inflammatory bowel disease (IBD), personal history of adenomatous polyps, or personal history of colorectal cancer; Surveillance: inflammatory bowel disease (IBD), including ulcerative colitis or Crohn's disease — colorectal cancer surveillance with colonoscopy, flexible sigmoidoscopy, or DCBE is medically necessary as frequently as every year; Surveillance: personal history of adenomatous polyps — surveillance is medically necessary as frequently as every 2 years; Surveillance: personal history of colorectal cancer — surveillance is medically necessary as frequently as every year; Annual FOBT, alone or in conjunction with sigmoidoscopy, is medically necessary for surveillance of colorectal cancer; Diagnostic testing with FOBT, colonoscopy, sigmoidoscopy, and/or DCBE is medically necessary for evaluation of members with signs or symptoms of colorectal cancer or other gastrointestinal diseases; Biopsy of lower GI tract — microscopic colitis: 8 or more biopsies medically necessary in persons with symptoms suggestive of microscopic colitis (e.g., diarrhea and/or functional abdominal pain), with 2 or more taken from each of the ascending, transverse, descending, and sigmoid colon; Biopsy of lower GI tract — inflammatory bowel disease diagnosis: 2 or more biopsies from 5 different locations, including the ileum and rectum; Biopsy of lower GI tract — inflammatory bowel disease screening for dysplasia: targeted biopsies PLUS, for pancolitis or segmental colitis, biopsies from the 4 quadrants every 10 cm; Biopsy of lower GI tract — pouchitis: multiple biopsies from the pouch and afferent loop; Biopsy of lower GI tract — colonic polyps: biopsies of polyps that cannot be removed; Biopsy of lower GI tract — acute graft-versus-host disease: medically necessary with EITHER flexible sigmoidoscopy (4 or more biopsies from the rectum/sigmoid AND 4 or more biopsies from the left colon) OR ileocolonoscopy (4 or more biopsies from the terminal ileum, ascending colon, transverse colon, descending colon, and rectum/sigmoid colon). Applies to 13 codes: 45378, 45380, 45381, 45382, 45384, 45385, 45386, 45388, 45390, 82270, G0104, G0105, G0121. Confirm prior-authorization status with Aetna before scheduling — it is code- and plan-specific, and this policy is not an exact authorization source. Documentation: Providers may be required to submit photographs of mucosal abnormalities seen on colonoscopy. Policy exclusions and limitations: Routine colorectal cancer screening for members 85 years of age or older is considered not medically necessary UNLESS life expectancy is greater than or equal to 10 years; Experimental, investigational, or unproven: Artificial intelligence-aided colonoscopy (including computer-aided colonoscopy); Experimental, investigational, or unproven: Blood-based protein biomarkers (e.g., BeScreened-CRC, Beacon Biomedical, Inc.); Experimental, investigational, or unproven: Capsule endoscopy; Experimental, investigational, or unproven: CD3 immuno-staining; Experimental, investigational, or unproven: Chromoendoscopy or narrow-band imaging optical colonoscopy; Experimental, investigational, or unproven: Colon AiQ; Experimental, investigational, or unproven: Fecal volatile organic compounds; Experimental, investigational, or unproven: Full-spectrum endoscopy (FUSE) colonoscopy; Experimental, investigational, or unproven: Guardant Shield Test; Experimental, investigational, or unproven: Methylated Septin 9 (ColoVantage, Epi proColon); Experimental, investigational, or unproven: MicroRNAs; Experimental, investigational, or unproven: Performance of multiple screening strategies simultaneously in the same individual (e.g., virtual colonoscopy screening every 5 years plus stool DNA testing every 3 years); Experimental, investigational, or unproven: Plasma/serum biomarkers (C-reactive protein, complement C3a anaphylatoxin, plasma GATA5 and SFRP2 methylation, serum CD26 [sCD26], serum matrix metalloproteinase-7 [MMP-7], and tissue inhibitor of metalloproteinases [TIMP-1]); Experimental, investigational, or unproven: PolypDx (Atlantic Diagnostic Laboratories, LLC, Metabolomic Technologies Inc.); Experimental, investigational, or unproven: Screening beginning at earlier than standard recommended ages for persons at increased risk due to smoking or obesity; Experimental, investigational, or unproven: SimpliPro Colon Test; Experimental, investigational, or unproven: Stool-based protein biomarkers; Experimental, investigational, or unproven: Stool molecular genetic tests other than Cologuard (e.g., ColoCaller Test, ColoSense multi-target stool RNA test, ColoSure, PreGen-Plus); Experimental, investigational, or unproven: Whole-blood DNA methylation markers; Experimental, investigational, or unproven: Screening for anal cytological abnormalities (anal Pap smear) or for anal human papillomavirus (HPV) infection — because of the lack of evidence that such screening improves clinical outcomes; Experimental, investigational, or unproven: Drug-coated balloon for the treatment of colonic strictures; Experimental, investigational, or unproven: Full-thickness resection device (FTRD) for endoscopic resection of appendiceal polyp. Claims may be denied when the requested service falls under these. Some of these are conditional (note the stated exceptions) — confirm specifics against the bulletin.
Does Aetna require prior authorization for Colorectal Cancer Screening?
Confirm prior-authorization status with Aetna before scheduling — it is code- and plan-specific, and this policy is not an exact authorization source. Documentation: Providers may be required to submit photographs of mucosal abnormalities seen on colonoscopy.
What does Aetna exclude for Colorectal Cancer Screening?
Policy exclusions and limitations: Routine colorectal cancer screening for members 85 years of age or older is considered not medically necessary UNLESS life expectancy is greater than or equal to 10 years; Experimental, investigational, or unproven: Artificial intelligence-aided colonoscopy (including computer-aided colonoscopy); Experimental, investigational, or unproven: Blood-based protein biomarkers (e.g., BeScreened-CRC, Beacon Biomedical, Inc.); Experimental, investigational, or unproven: Capsule endoscopy; Experimental, investigational, or unproven: CD3 immuno-staining; Experimental, investigational, or unproven: Chromoendoscopy or narrow-band imaging optical colonoscopy; Experimental, investigational, or unproven: Colon AiQ; Experimental, investigational, or unproven: Fecal volatile organic compounds; Experimental, investigational, or unproven: Full-spectrum endoscopy (FUSE) colonoscopy; Experimental, investigational, or unproven: Guardant Shield Test; Experimental, investigational, or unproven: Methylated Septin 9 (ColoVantage, Epi proColon); Experimental, investigational, or unproven: MicroRNAs; Experimental, investigational, or unproven: Performance of multiple screening strategies simultaneously in the same individual (e.g., virtual colonoscopy screening every 5 years plus stool DNA testing every 3 years); Experimental, investigational, or unproven: Plasma/serum biomarkers (C-reactive protein, complement C3a anaphylatoxin, plasma GATA5 and SFRP2 methylation, serum CD26 [sCD26], serum matrix metalloproteinase-7 [MMP-7], and tissue inhibitor of metalloproteinases [TIMP-1]); Experimental, investigational, or unproven: PolypDx (Atlantic Diagnostic Laboratories, LLC, Metabolomic Technologies Inc.); Experimental, investigational, or unproven: Screening beginning at earlier than standard recommended ages for persons at increased risk due to smoking or obesity; Experimental, investigational, or unproven: SimpliPro Colon Test; Experimental, investigational, or unproven: Stool-based protein biomarkers; Experimental, investigational, or unproven: Stool molecular genetic tests other than Cologuard (e.g., ColoCaller Test, ColoSense multi-target stool RNA test, ColoSure, PreGen-Plus); Experimental, investigational, or unproven: Whole-blood DNA methylation markers; Experimental, investigational, or unproven: Screening for anal cytological abnormalities (anal Pap smear) or for anal human papillomavirus (HPV) infection — because of the lack of evidence that such screening improves clinical outcomes; Experimental, investigational, or unproven: Drug-coated balloon for the treatment of colonic strictures; Experimental, investigational, or unproven: Full-thickness resection device (FTRD) for endoscopic resection of appendiceal polyp. Claims may be denied when the requested service falls under these. Some of these are conditional (note the stated exceptions) — confirm specifics against the bulletin.

Source

Aetna CPB 0516 — Colorectal Cancer Screening

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Coverage disclaimer

This page summarizes Aetna clinical-coverage criteria extracted from policy CPB 0516 for educational purposes. Coverage policies change and vary by individual plan. Always verify against Aetna's current policy before performing a procedure or submitting a claim. d3rx is not responsible for claim denials or reimbursement issues.