Aetna · Clinical coverage policy

Aetna Parkinson's Disease coverage criteria

Aetna CPB 0307 covers select diagnostic tests for Parkinson's disease (levodopa/apomorphine challenge when diagnosis is in doubt, UPSIT or Sniffin' Sticks olfactory testing, neuropsychological testing, and DaTSCAN SPECT to distinguish PD from essential tremor), carbidopa-levodopa enteral suspension (Duopa) and foscarbidopa/foslevodopa (Vyalev) with their infusion pumps for levodopa-responsive patients with significant daily 'off' time who have failed oral therapy plus another anti-Parkinson agent, and pallidotomy for idiopathic PD that has failed medical therapy. A long list of biomarkers, genetic panels, alternative devices/therapies, and most other surgical procedures (e.g., MRI-guided focused ultrasound, gene therapy, stem cell and fetal-tissue transplantation, sub-thalamotomy, Gamma Knife pallidotomy) are deemed experimental/investigational and not covered; pallidotomy is excluded in Parkinson's-plus syndromes, severe dementia/cerebral atrophy, and Hoehn-Yahr Stage V. The bulletin is silent on precertification/prior authorization.

Policy CPB 0307 · Effective · Verify against the current Aetna policy before submitting — view source policy.

Payer

Aetna

Policy

CPB 0307

Prior auth

Confirm

Effective

January 1, 2026

This page reflects the coverage criteria captured from Aetna policy CPB 0307 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 Parkinson's Disease (CPT 96132), and what gets it denied?

Path
Aetna CPB 0307 covers select diagnostic tests for Parkinson's disease (levodopa/apomorphine challenge when diagnosis is in doubt, UPSIT or Sniffin' Sticks olfactory testing, neuropsychological testing, and DaTSCAN SPECT to distinguish PD from essential tremor), carbidopa-levodopa enteral suspension (Duopa) and foscarbidopa/foslevodopa (Vyalev) with their infusion pumps for levodopa-responsive patients with significant daily 'off' time who have failed oral therapy plus another anti-Parkinson agent, and pallidotomy for idiopathic PD that has failed medical therapy. A long list of biomarkers, genetic panels, alternative devices/therapies, and most other surgical procedures (e.g., MRI-guided focused ultrasound, gene therapy, stem cell and fetal-tissue transplantation, sub-thalamotomy, Gamma Knife pallidotomy) are deemed experimental/investigational and not covered; pallidotomy is excluded in Parkinson's-plus syndromes, severe dementia/cerebral atrophy, and Hoehn-Yahr Stage V. The bulletin is silent on precertification/prior authorization. Coverage criteria include: Diagnosis: Levodopa or apomorphine challenge when the diagnosis of PD is in doubt is considered medically necessary.; Diagnosis: Olfactory testing by means of the University of Pennsylvania Smell Identification Test (UPSIT) or 'Sniffin' Sticks' to differentiate PD from progressive supranuclear palsy and cortico-basal degeneration is considered medically necessary.; Diagnosis: Neuropsychological testing for the diagnosis of PD is considered medically necessary.; Diagnosis: SPECT scanning (e.g., DaTSCAN) to distinguish PD from essential tremor is considered medically necessary.; Carbidopa and Levodopa Enteral Suspension (Duopa) - Prescriber Specialties: This medication must be prescribed by or in consultation with a neurologist or a specialist in the treatment of Parkinson's disease.; Duopa - Initial approval (meet ALL of): (1) The member is levodopa responsive with clearly defined 'on' periods; AND (2) The member has 'off' periods of at least 3 hours per day despite optimization efforts; AND (3) The member must have had an inadequate response or intolerable adverse event with oral carbidopa-levodopa AND with ONE of the following anti-Parkinson agents: Catechol-O-methyltransferase (COMT) inhibitor (e.g., entacapone, tolcapone); OR Dopamine agonists (e.g., pramipexole, ropinirole); OR Monoamine oxidase-B (MAO-B) inhibitor (e.g., selegiline, rasagiline).; Duopa - Continuation of therapy: For continued treatment of members with advanced PD who have demonstrated a positive clinical response to Duopa therapy.; CADD-Legacy 1400 portable infusion pump for administering carbidopa and levodopa enteral suspension is considered medically necessary durable medical equipment (DME) for persons who meet criteria for carbidopa and levodopa enteral suspension (Duopa).; Vyafuser ambulatory infusion pump for administering foscarbidopa / foslevodopa is considered medically necessary DME for persons with Parkinson's disease who meet criteria for foscarbidopa / foslevodopa (Vyalev).; Pallidotomy for the treatment of PD is considered medically necessary when ALL of the following criteria are met: (1) Individuals with idiopathic PD who have tried and failed medical therapy as indicated by worsening of Parkinsonian symptoms and/or disabling medication side effects (motor fluctuations with 'wearing off', and unpredictable 'on/off', as well as Sinemet-induced dyskinesia); AND (2) Members exhibit 2 of 4 major symptoms (bradykinesia, tremor, rigidity, and gait disturbance); AND (3) Members have a history of positive response to dopaminergic replacement therapy (e.g., Sinemet or bromocriptine); AND (4) Members have been screened by a neurologist who has expertise in movement disorders to ensure all reasonable forms of pharmacotherapies have been tried and failed.. Applies to 8 codes: 96132, 96133, 78607, 61720, A9584, J7340, E0779, E0781.
Action
Confirm prior-authorization status with Aetna before scheduling — it is code- and plan-specific, and this policy is not an exact authorization source.
Trap
Policy exclusions and limitations: Pallidotomy for the treatment of PD is of no proven value (NOT covered) in persons with the following conditions (ONE of): Members with Parkinson's plus or atypical Parkinson's disorders (e.g., multi-system atrophy, striato-nigral degeneration, progressive supranuclear palsy, or combined Alzheimer's disease and PD); OR Members with severe dementia or cerebral atrophy; OR Members with Hoehn and Yahr Stage V Parkinson's disease.; Experimental/investigational/unproven for differentiating PD from other parkinsonian syndromes: Electrooculography.; Experimental/investigational/unproven for differentiating PD from other parkinsonian syndromes: Growth hormone stimulation with clonidine.; Experimental/investigational/unproven for differentiating PD from other parkinsonian syndromes: Iodine-123 meta-iodobenzylguanidine (MIBG) cardiac imaging.; Experimental/investigational/unproven for differentiating PD from other parkinsonian syndromes: Magnetic resonance imaging (MRI).; Experimental/investigational/unproven for differentiating PD from other parkinsonian syndromes: Tilt table testing.; Experimental/investigational/unproven for differentiating PD from other parkinsonian syndromes: Transcranial duplex scanning.; SPECT scanning is considered experimental, investigational, and unproven for distinguishing PD from other parkinsonian syndromes, and for monitoring the progression of PD.; Experimental/investigational/unproven biomarker: Alpha-synuclein (SNCA) in blood, cerebrospinal fluid, salivary extracellular vesicles, and cutaneous specimens (including the Syn-One test and the SYNTap Biomarker Test).; Experimental/investigational/unproven biomarker: Apolipoprotein E (APOE).; Experimental/investigational/unproven biomarker: DJ1 (PARK7).; Experimental/investigational/unproven biomarker: Fibroblast growth factor 20 rs12720208 polymorphism.; Experimental/investigational/unproven biomarker: Glutathione S-transferase M1 (GSTM1) and glutathione S-transferase T1 (GSTT1) polymorphisms.; Experimental/investigational/unproven biomarker: Interleukin-10 polymorphisms (-1082A/G and -592C/A).; Experimental/investigational/unproven biomarker: LRRK2/PARK8.; Experimental/investigational/unproven biomarker: Mitochondrial DNA (mtDNA) copy number levels in blood.; Experimental/investigational/unproven biomarker: Parkin/PARK2.; Experimental/investigational/unproven biomarker: PARK10 and its variants.; Experimental/investigational/unproven biomarker: PINK1.; Experimental/investigational/unproven biomarker: PITX3.; Experimental/investigational/unproven biomarker: Sphingomyelin phosphodiesterase 1 gene (SMPD1).; Experimental/investigational/unproven biomarker: CSF amyloid beta 1-42 as a biomarker for PD progression.; Experimental/investigational/unproven biomarker: Heart fatty acid-binding protein.; Experimental/investigational/unproven biomarker: Neurofilament light chain (NfL) (phosphorylated or total).; Experimental/investigational/unproven biomarker: Ubiquitin carboxy-terminal hydrolase L1 (UCH-L1).; Experimental/investigational/unproven biomarker: Serum fibroblast growth factor 21 (FGF21).; Experimental/investigational/unproven biomarker: Serum growth differentiation factor 15 (GDF-15).; Experimental/investigational/unproven biomarker: Serum leptin levels for diagnosis of PD.; Experimental/investigational/unproven: Urinary LRRK2 phosphorylation to determine PD risk among LRRK2 mutation carriers.; Experimental/investigational/unproven: Metabolic profiling for PD.; Experimental/investigational/unproven: Quantitative EEG (qEEG) measures as predictive biomarkers for development of dementia in PD.; Experimental/investigational/unproven: Retinal thinning as a biomarker of PD.; Experimental/investigational/unproven: Salivary biomarkers (acetylcholinesterase, alpha-synuclein, cortisol, heme oxygenase-1, nitric oxide).; Experimental/investigational/unproven: Submandibular gland needle biopsy for diagnosis of PD.; Experimental/investigational/unproven: Telomere length as a risk factor for development of PD.; Experimental/investigational/unproven: Use of genetic panels - Complete Dopa-Responsive Dystonia (DYT5); Complete Parkinsonism Evaluation Panel; Isolated Dystonia Evaluation Panel.; Experimental/investigational/unproven: Use of wearable inertial sensors for home monitoring of individuals with PD.; Experimental/investigational/unproven non-surgical treatment: Alpha-synuclein immunotherapy for treatment of PD.; Experimental/investigational/unproven non-surgical treatment: Bright light therapy for treatment of depression in PD.; Experimental/investigational/unproven non-surgical treatment: Cala-Trio device for treatment of essential and Parkinsonian tremor.; Experimental/investigational/unproven non-surgical treatment: Cannabinoids for treatment of PD.; Experimental/investigational/unproven non-surgical treatment: Copper gloves for reducing tremor in PD.; Experimental/investigational/unproven non-surgical treatment: Cueing module device (auditory cue) for treatment of Parkinson's freezing.; Experimental/investigational/unproven non-surgical treatment: Hyperbaric oxygen therapy.; Experimental/investigational/unproven non-surgical treatment: Intravenous glutathione.; Experimental/investigational/unproven non-surgical treatment: Music-based interventions for treatment of motor and non-motor symptoms.; Experimental/investigational/unproven non-surgical treatment: Proprioceptive focal stimulation (Equistasi device) for gait and postural balance rehabilitation.; Experimental/investigational/unproven non-surgical treatment: Robot-assisted gait training on lower extremity dyskinesia.; Experimental/investigational/unproven non-surgical treatment: Transcranial direct current stimulation / transcranial magnetic stimulation (including theta burst stimulation-patterned transcranial magnetic stimulation).; Experimental/investigational/unproven non-surgical treatment: Tumor necrosis factor inhibition for prevention of PD or delay of its onset.; Experimental/investigational/unproven non-surgical treatment: Wearable in-ear speech aide device (SpeechVive).; Experimental/investigational/unproven surgical treatment: Adrenal medullary transplantation.; Experimental/investigational/unproven surgical treatment: Extra-dural motor cortex stimulation.; Experimental/investigational/unproven surgical treatment: Gamma Knife caudatotomy / Gamma Knife pallidotomy for treatment of motor symptoms in PD.; Experimental/investigational/unproven surgical treatment: Gene therapy, including aromatic L-amino acid decarboxylase (AADC) gene therapy (via putaminal infusion).; Experimental/investigational/unproven surgical treatment: Intra-striatal implantation of human retinal pigment epithelial cells.; Experimental/investigational/unproven surgical treatment: Magnetic resonance imaging-guided focused ultrasound neurosurgery.; Experimental/investigational/unproven surgical treatment: Spinal cord stimulation for treatment of gait disorders.; Experimental/investigational/unproven surgical treatment: Stem cell transplantation.; Experimental/investigational/unproven surgical treatment: Sub-thalamotomy.; Experimental/investigational/unproven surgical treatment: Transplantation of fetal mesencephalic tissue or fetal xenografts (e.g., from pigs or other animals).; Experimental/investigational/unproven surgical treatment: Vagotomy for prevention and treatment of PD. Claims may be denied when the requested service falls under these.

Source: Aetna CPB 0307 — Parkinson's Disease

Coverage criteria

  • Diagnosis: Levodopa or apomorphine challenge when the diagnosis of PD is in doubt is considered medically necessary.
  • Diagnosis: Olfactory testing by means of the University of Pennsylvania Smell Identification Test (UPSIT) or 'Sniffin' Sticks' to differentiate PD from progressive supranuclear palsy and cortico-basal degeneration is considered medically necessary.
  • Diagnosis: Neuropsychological testing for the diagnosis of PD is considered medically necessary.
  • Diagnosis: SPECT scanning (e.g., DaTSCAN) to distinguish PD from essential tremor is considered medically necessary.
  • Carbidopa and Levodopa Enteral Suspension (Duopa) - Prescriber Specialties: This medication must be prescribed by or in consultation with a neurologist or a specialist in the treatment of Parkinson's disease.
  • Duopa - Initial approval (meet ALL of): (1) The member is levodopa responsive with clearly defined 'on' periods; AND (2) The member has 'off' periods of at least 3 hours per day despite optimization efforts; AND (3) The member must have had an inadequate response or intolerable adverse event with oral carbidopa-levodopa AND with ONE of the following anti-Parkinson agents: Catechol-O-methyltransferase (COMT) inhibitor (e.g., entacapone, tolcapone); OR Dopamine agonists (e.g., pramipexole, ropinirole); OR Monoamine oxidase-B (MAO-B) inhibitor (e.g., selegiline, rasagiline).
  • Duopa - Continuation of therapy: For continued treatment of members with advanced PD who have demonstrated a positive clinical response to Duopa therapy.
  • CADD-Legacy 1400 portable infusion pump for administering carbidopa and levodopa enteral suspension is considered medically necessary durable medical equipment (DME) for persons who meet criteria for carbidopa and levodopa enteral suspension (Duopa).
  • Vyafuser ambulatory infusion pump for administering foscarbidopa / foslevodopa is considered medically necessary DME for persons with Parkinson's disease who meet criteria for foscarbidopa / foslevodopa (Vyalev).
  • Pallidotomy for the treatment of PD is considered medically necessary when ALL of the following criteria are met: (1) Individuals with idiopathic PD who have tried and failed medical therapy as indicated by worsening of Parkinsonian symptoms and/or disabling medication side effects (motor fluctuations with 'wearing off', and unpredictable 'on/off', as well as Sinemet-induced dyskinesia); AND (2) Members exhibit 2 of 4 major symptoms (bradykinesia, tremor, rigidity, and gait disturbance); AND (3) Members have a history of positive response to dopaminergic replacement therapy (e.g., Sinemet or bromocriptine); AND (4) Members have been screened by a neurologist who has expertise in movement disorders to ensure all reasonable forms of pharmacotherapies have been tried and failed.

Covered codes

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

Frequently asked questions

When does Aetna cover Parkinson's Disease (CPT 96132), and what gets it denied?
Aetna CPB 0307 covers select diagnostic tests for Parkinson's disease (levodopa/apomorphine challenge when diagnosis is in doubt, UPSIT or Sniffin' Sticks olfactory testing, neuropsychological testing, and DaTSCAN SPECT to distinguish PD from essential tremor), carbidopa-levodopa enteral suspension (Duopa) and foscarbidopa/foslevodopa (Vyalev) with their infusion pumps for levodopa-responsive patients with significant daily 'off' time who have failed oral therapy plus another anti-Parkinson agent, and pallidotomy for idiopathic PD that has failed medical therapy. A long list of biomarkers, genetic panels, alternative devices/therapies, and most other surgical procedures (e.g., MRI-guided focused ultrasound, gene therapy, stem cell and fetal-tissue transplantation, sub-thalamotomy, Gamma Knife pallidotomy) are deemed experimental/investigational and not covered; pallidotomy is excluded in Parkinson's-plus syndromes, severe dementia/cerebral atrophy, and Hoehn-Yahr Stage V. The bulletin is silent on precertification/prior authorization. Coverage criteria include: Diagnosis: Levodopa or apomorphine challenge when the diagnosis of PD is in doubt is considered medically necessary.; Diagnosis: Olfactory testing by means of the University of Pennsylvania Smell Identification Test (UPSIT) or 'Sniffin' Sticks' to differentiate PD from progressive supranuclear palsy and cortico-basal degeneration is considered medically necessary.; Diagnosis: Neuropsychological testing for the diagnosis of PD is considered medically necessary.; Diagnosis: SPECT scanning (e.g., DaTSCAN) to distinguish PD from essential tremor is considered medically necessary.; Carbidopa and Levodopa Enteral Suspension (Duopa) - Prescriber Specialties: This medication must be prescribed by or in consultation with a neurologist or a specialist in the treatment of Parkinson's disease.; Duopa - Initial approval (meet ALL of): (1) The member is levodopa responsive with clearly defined 'on' periods; AND (2) The member has 'off' periods of at least 3 hours per day despite optimization efforts; AND (3) The member must have had an inadequate response or intolerable adverse event with oral carbidopa-levodopa AND with ONE of the following anti-Parkinson agents: Catechol-O-methyltransferase (COMT) inhibitor (e.g., entacapone, tolcapone); OR Dopamine agonists (e.g., pramipexole, ropinirole); OR Monoamine oxidase-B (MAO-B) inhibitor (e.g., selegiline, rasagiline).; Duopa - Continuation of therapy: For continued treatment of members with advanced PD who have demonstrated a positive clinical response to Duopa therapy.; CADD-Legacy 1400 portable infusion pump for administering carbidopa and levodopa enteral suspension is considered medically necessary durable medical equipment (DME) for persons who meet criteria for carbidopa and levodopa enteral suspension (Duopa).; Vyafuser ambulatory infusion pump for administering foscarbidopa / foslevodopa is considered medically necessary DME for persons with Parkinson's disease who meet criteria for foscarbidopa / foslevodopa (Vyalev).; Pallidotomy for the treatment of PD is considered medically necessary when ALL of the following criteria are met: (1) Individuals with idiopathic PD who have tried and failed medical therapy as indicated by worsening of Parkinsonian symptoms and/or disabling medication side effects (motor fluctuations with 'wearing off', and unpredictable 'on/off', as well as Sinemet-induced dyskinesia); AND (2) Members exhibit 2 of 4 major symptoms (bradykinesia, tremor, rigidity, and gait disturbance); AND (3) Members have a history of positive response to dopaminergic replacement therapy (e.g., Sinemet or bromocriptine); AND (4) Members have been screened by a neurologist who has expertise in movement disorders to ensure all reasonable forms of pharmacotherapies have been tried and failed.. Applies to 8 codes: 96132, 96133, 78607, 61720, A9584, J7340, E0779, E0781. Confirm prior-authorization status with Aetna before scheduling — it is code- and plan-specific, and this policy is not an exact authorization source. Policy exclusions and limitations: Pallidotomy for the treatment of PD is of no proven value (NOT covered) in persons with the following conditions (ONE of): Members with Parkinson's plus or atypical Parkinson's disorders (e.g., multi-system atrophy, striato-nigral degeneration, progressive supranuclear palsy, or combined Alzheimer's disease and PD); OR Members with severe dementia or cerebral atrophy; OR Members with Hoehn and Yahr Stage V Parkinson's disease.; Experimental/investigational/unproven for differentiating PD from other parkinsonian syndromes: Electrooculography.; Experimental/investigational/unproven for differentiating PD from other parkinsonian syndromes: Growth hormone stimulation with clonidine.; Experimental/investigational/unproven for differentiating PD from other parkinsonian syndromes: Iodine-123 meta-iodobenzylguanidine (MIBG) cardiac imaging.; Experimental/investigational/unproven for differentiating PD from other parkinsonian syndromes: Magnetic resonance imaging (MRI).; Experimental/investigational/unproven for differentiating PD from other parkinsonian syndromes: Tilt table testing.; Experimental/investigational/unproven for differentiating PD from other parkinsonian syndromes: Transcranial duplex scanning.; SPECT scanning is considered experimental, investigational, and unproven for distinguishing PD from other parkinsonian syndromes, and for monitoring the progression of PD.; Experimental/investigational/unproven biomarker: Alpha-synuclein (SNCA) in blood, cerebrospinal fluid, salivary extracellular vesicles, and cutaneous specimens (including the Syn-One test and the SYNTap Biomarker Test).; Experimental/investigational/unproven biomarker: Apolipoprotein E (APOE).; Experimental/investigational/unproven biomarker: DJ1 (PARK7).; Experimental/investigational/unproven biomarker: Fibroblast growth factor 20 rs12720208 polymorphism.; Experimental/investigational/unproven biomarker: Glutathione S-transferase M1 (GSTM1) and glutathione S-transferase T1 (GSTT1) polymorphisms.; Experimental/investigational/unproven biomarker: Interleukin-10 polymorphisms (-1082A/G and -592C/A).; Experimental/investigational/unproven biomarker: LRRK2/PARK8.; Experimental/investigational/unproven biomarker: Mitochondrial DNA (mtDNA) copy number levels in blood.; Experimental/investigational/unproven biomarker: Parkin/PARK2.; Experimental/investigational/unproven biomarker: PARK10 and its variants.; Experimental/investigational/unproven biomarker: PINK1.; Experimental/investigational/unproven biomarker: PITX3.; Experimental/investigational/unproven biomarker: Sphingomyelin phosphodiesterase 1 gene (SMPD1).; Experimental/investigational/unproven biomarker: CSF amyloid beta 1-42 as a biomarker for PD progression.; Experimental/investigational/unproven biomarker: Heart fatty acid-binding protein.; Experimental/investigational/unproven biomarker: Neurofilament light chain (NfL) (phosphorylated or total).; Experimental/investigational/unproven biomarker: Ubiquitin carboxy-terminal hydrolase L1 (UCH-L1).; Experimental/investigational/unproven biomarker: Serum fibroblast growth factor 21 (FGF21).; Experimental/investigational/unproven biomarker: Serum growth differentiation factor 15 (GDF-15).; Experimental/investigational/unproven biomarker: Serum leptin levels for diagnosis of PD.; Experimental/investigational/unproven: Urinary LRRK2 phosphorylation to determine PD risk among LRRK2 mutation carriers.; Experimental/investigational/unproven: Metabolic profiling for PD.; Experimental/investigational/unproven: Quantitative EEG (qEEG) measures as predictive biomarkers for development of dementia in PD.; Experimental/investigational/unproven: Retinal thinning as a biomarker of PD.; Experimental/investigational/unproven: Salivary biomarkers (acetylcholinesterase, alpha-synuclein, cortisol, heme oxygenase-1, nitric oxide).; Experimental/investigational/unproven: Submandibular gland needle biopsy for diagnosis of PD.; Experimental/investigational/unproven: Telomere length as a risk factor for development of PD.; Experimental/investigational/unproven: Use of genetic panels - Complete Dopa-Responsive Dystonia (DYT5); Complete Parkinsonism Evaluation Panel; Isolated Dystonia Evaluation Panel.; Experimental/investigational/unproven: Use of wearable inertial sensors for home monitoring of individuals with PD.; Experimental/investigational/unproven non-surgical treatment: Alpha-synuclein immunotherapy for treatment of PD.; Experimental/investigational/unproven non-surgical treatment: Bright light therapy for treatment of depression in PD.; Experimental/investigational/unproven non-surgical treatment: Cala-Trio device for treatment of essential and Parkinsonian tremor.; Experimental/investigational/unproven non-surgical treatment: Cannabinoids for treatment of PD.; Experimental/investigational/unproven non-surgical treatment: Copper gloves for reducing tremor in PD.; Experimental/investigational/unproven non-surgical treatment: Cueing module device (auditory cue) for treatment of Parkinson's freezing.; Experimental/investigational/unproven non-surgical treatment: Hyperbaric oxygen therapy.; Experimental/investigational/unproven non-surgical treatment: Intravenous glutathione.; Experimental/investigational/unproven non-surgical treatment: Music-based interventions for treatment of motor and non-motor symptoms.; Experimental/investigational/unproven non-surgical treatment: Proprioceptive focal stimulation (Equistasi device) for gait and postural balance rehabilitation.; Experimental/investigational/unproven non-surgical treatment: Robot-assisted gait training on lower extremity dyskinesia.; Experimental/investigational/unproven non-surgical treatment: Transcranial direct current stimulation / transcranial magnetic stimulation (including theta burst stimulation-patterned transcranial magnetic stimulation).; Experimental/investigational/unproven non-surgical treatment: Tumor necrosis factor inhibition for prevention of PD or delay of its onset.; Experimental/investigational/unproven non-surgical treatment: Wearable in-ear speech aide device (SpeechVive).; Experimental/investigational/unproven surgical treatment: Adrenal medullary transplantation.; Experimental/investigational/unproven surgical treatment: Extra-dural motor cortex stimulation.; Experimental/investigational/unproven surgical treatment: Gamma Knife caudatotomy / Gamma Knife pallidotomy for treatment of motor symptoms in PD.; Experimental/investigational/unproven surgical treatment: Gene therapy, including aromatic L-amino acid decarboxylase (AADC) gene therapy (via putaminal infusion).; Experimental/investigational/unproven surgical treatment: Intra-striatal implantation of human retinal pigment epithelial cells.; Experimental/investigational/unproven surgical treatment: Magnetic resonance imaging-guided focused ultrasound neurosurgery.; Experimental/investigational/unproven surgical treatment: Spinal cord stimulation for treatment of gait disorders.; Experimental/investigational/unproven surgical treatment: Stem cell transplantation.; Experimental/investigational/unproven surgical treatment: Sub-thalamotomy.; Experimental/investigational/unproven surgical treatment: Transplantation of fetal mesencephalic tissue or fetal xenografts (e.g., from pigs or other animals).; Experimental/investigational/unproven surgical treatment: Vagotomy for prevention and treatment of PD. Claims may be denied when the requested service falls under these.
Does Aetna require prior authorization for Parkinson's Disease?
Confirm prior-authorization status with Aetna before scheduling — it is code- and plan-specific, and this policy is not an exact authorization source.
What does Aetna exclude for Parkinson's Disease?
Policy exclusions and limitations: Pallidotomy for the treatment of PD is of no proven value (NOT covered) in persons with the following conditions (ONE of): Members with Parkinson's plus or atypical Parkinson's disorders (e.g., multi-system atrophy, striato-nigral degeneration, progressive supranuclear palsy, or combined Alzheimer's disease and PD); OR Members with severe dementia or cerebral atrophy; OR Members with Hoehn and Yahr Stage V Parkinson's disease.; Experimental/investigational/unproven for differentiating PD from other parkinsonian syndromes: Electrooculography.; Experimental/investigational/unproven for differentiating PD from other parkinsonian syndromes: Growth hormone stimulation with clonidine.; Experimental/investigational/unproven for differentiating PD from other parkinsonian syndromes: Iodine-123 meta-iodobenzylguanidine (MIBG) cardiac imaging.; Experimental/investigational/unproven for differentiating PD from other parkinsonian syndromes: Magnetic resonance imaging (MRI).; Experimental/investigational/unproven for differentiating PD from other parkinsonian syndromes: Tilt table testing.; Experimental/investigational/unproven for differentiating PD from other parkinsonian syndromes: Transcranial duplex scanning.; SPECT scanning is considered experimental, investigational, and unproven for distinguishing PD from other parkinsonian syndromes, and for monitoring the progression of PD.; Experimental/investigational/unproven biomarker: Alpha-synuclein (SNCA) in blood, cerebrospinal fluid, salivary extracellular vesicles, and cutaneous specimens (including the Syn-One test and the SYNTap Biomarker Test).; Experimental/investigational/unproven biomarker: Apolipoprotein E (APOE).; Experimental/investigational/unproven biomarker: DJ1 (PARK7).; Experimental/investigational/unproven biomarker: Fibroblast growth factor 20 rs12720208 polymorphism.; Experimental/investigational/unproven biomarker: Glutathione S-transferase M1 (GSTM1) and glutathione S-transferase T1 (GSTT1) polymorphisms.; Experimental/investigational/unproven biomarker: Interleukin-10 polymorphisms (-1082A/G and -592C/A).; Experimental/investigational/unproven biomarker: LRRK2/PARK8.; Experimental/investigational/unproven biomarker: Mitochondrial DNA (mtDNA) copy number levels in blood.; Experimental/investigational/unproven biomarker: Parkin/PARK2.; Experimental/investigational/unproven biomarker: PARK10 and its variants.; Experimental/investigational/unproven biomarker: PINK1.; Experimental/investigational/unproven biomarker: PITX3.; Experimental/investigational/unproven biomarker: Sphingomyelin phosphodiesterase 1 gene (SMPD1).; Experimental/investigational/unproven biomarker: CSF amyloid beta 1-42 as a biomarker for PD progression.; Experimental/investigational/unproven biomarker: Heart fatty acid-binding protein.; Experimental/investigational/unproven biomarker: Neurofilament light chain (NfL) (phosphorylated or total).; Experimental/investigational/unproven biomarker: Ubiquitin carboxy-terminal hydrolase L1 (UCH-L1).; Experimental/investigational/unproven biomarker: Serum fibroblast growth factor 21 (FGF21).; Experimental/investigational/unproven biomarker: Serum growth differentiation factor 15 (GDF-15).; Experimental/investigational/unproven biomarker: Serum leptin levels for diagnosis of PD.; Experimental/investigational/unproven: Urinary LRRK2 phosphorylation to determine PD risk among LRRK2 mutation carriers.; Experimental/investigational/unproven: Metabolic profiling for PD.; Experimental/investigational/unproven: Quantitative EEG (qEEG) measures as predictive biomarkers for development of dementia in PD.; Experimental/investigational/unproven: Retinal thinning as a biomarker of PD.; Experimental/investigational/unproven: Salivary biomarkers (acetylcholinesterase, alpha-synuclein, cortisol, heme oxygenase-1, nitric oxide).; Experimental/investigational/unproven: Submandibular gland needle biopsy for diagnosis of PD.; Experimental/investigational/unproven: Telomere length as a risk factor for development of PD.; Experimental/investigational/unproven: Use of genetic panels - Complete Dopa-Responsive Dystonia (DYT5); Complete Parkinsonism Evaluation Panel; Isolated Dystonia Evaluation Panel.; Experimental/investigational/unproven: Use of wearable inertial sensors for home monitoring of individuals with PD.; Experimental/investigational/unproven non-surgical treatment: Alpha-synuclein immunotherapy for treatment of PD.; Experimental/investigational/unproven non-surgical treatment: Bright light therapy for treatment of depression in PD.; Experimental/investigational/unproven non-surgical treatment: Cala-Trio device for treatment of essential and Parkinsonian tremor.; Experimental/investigational/unproven non-surgical treatment: Cannabinoids for treatment of PD.; Experimental/investigational/unproven non-surgical treatment: Copper gloves for reducing tremor in PD.; Experimental/investigational/unproven non-surgical treatment: Cueing module device (auditory cue) for treatment of Parkinson's freezing.; Experimental/investigational/unproven non-surgical treatment: Hyperbaric oxygen therapy.; Experimental/investigational/unproven non-surgical treatment: Intravenous glutathione.; Experimental/investigational/unproven non-surgical treatment: Music-based interventions for treatment of motor and non-motor symptoms.; Experimental/investigational/unproven non-surgical treatment: Proprioceptive focal stimulation (Equistasi device) for gait and postural balance rehabilitation.; Experimental/investigational/unproven non-surgical treatment: Robot-assisted gait training on lower extremity dyskinesia.; Experimental/investigational/unproven non-surgical treatment: Transcranial direct current stimulation / transcranial magnetic stimulation (including theta burst stimulation-patterned transcranial magnetic stimulation).; Experimental/investigational/unproven non-surgical treatment: Tumor necrosis factor inhibition for prevention of PD or delay of its onset.; Experimental/investigational/unproven non-surgical treatment: Wearable in-ear speech aide device (SpeechVive).; Experimental/investigational/unproven surgical treatment: Adrenal medullary transplantation.; Experimental/investigational/unproven surgical treatment: Extra-dural motor cortex stimulation.; Experimental/investigational/unproven surgical treatment: Gamma Knife caudatotomy / Gamma Knife pallidotomy for treatment of motor symptoms in PD.; Experimental/investigational/unproven surgical treatment: Gene therapy, including aromatic L-amino acid decarboxylase (AADC) gene therapy (via putaminal infusion).; Experimental/investigational/unproven surgical treatment: Intra-striatal implantation of human retinal pigment epithelial cells.; Experimental/investigational/unproven surgical treatment: Magnetic resonance imaging-guided focused ultrasound neurosurgery.; Experimental/investigational/unproven surgical treatment: Spinal cord stimulation for treatment of gait disorders.; Experimental/investigational/unproven surgical treatment: Stem cell transplantation.; Experimental/investigational/unproven surgical treatment: Sub-thalamotomy.; Experimental/investigational/unproven surgical treatment: Transplantation of fetal mesencephalic tissue or fetal xenografts (e.g., from pigs or other animals).; Experimental/investigational/unproven surgical treatment: Vagotomy for prevention and treatment of PD. Claims may be denied when the requested service falls under these.

Source

Aetna CPB 0307 — Parkinson's Disease

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This page summarizes Aetna clinical-coverage criteria extracted from policy CPB 0307 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.