Aetna · Clinical coverage policy

Aetna Viscosupplementation for Osteoarthritis coverage criteria

Aetna covers viscosupplementation (hyaluronate injections) only for knee osteoarthritis, and only when the member has documented OA (radiographic evidence or at least 5 of 9 clinical signs), pain interfering with function, and has failed or cannot tolerate non-drug therapy plus at least a 3-month trial each of analgesics and intra-articular steroids, with no total knee replacement scheduled within 6 months. Use in any other joint (hip, ankle, shoulder, TMJ, etc.) or for other conditions, and combination with corticosteroids/PRP/stem cells, is considered not medically necessary; precertification is explicitly required.

Policy CPB 0179 · Effective · Verify against the current Aetna policy before submitting — view source policy.

Payer

Aetna

Policy

CPB 0179

Prior auth

Confirm

Effective

January 1, 2026

This page reflects the coverage criteria captured from Aetna policy CPB 0179 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 Viscosupplementation for Osteoarthritis (CPT 20610), and what gets it denied?

Path
Aetna covers viscosupplementation (hyaluronate injections) only for knee osteoarthritis, and only when the member has documented OA (radiographic evidence or at least 5 of 9 clinical signs), pain interfering with function, and has failed or cannot tolerate non-drug therapy plus at least a 3-month trial each of analgesics and intra-articular steroids, with no total knee replacement scheduled within 6 months. Use in any other joint (hip, ankle, shoulder, TMJ, etc.) or for other conditions, and combination with corticosteroids/PRP/stem cells, is considered not medically necessary; precertification is explicitly required. Coverage criteria include: Viscosupplementation (hyaluronates) is medically necessary for treatment of osteoarthritis (OA) in the KNEE ONLY when ALL of the criteria for initial approval below are met (joints other than the knee are NOT covered).; Initial approval (ALL of A-F required) — A. Diagnosis supported by EITHER (ONE of): (1) radiographic evidence of osteoarthritis of the knee (joint space narrowing, subchondral sclerosis, osteophytes, subchondral cysts); OR (2) at least 5 of these 9 signs/symptoms: bony enlargement; bony tenderness; crepitus on active motion; ESR less than 40 mm/hr; less than 30 minutes of morning stiffness; no palpable warmth of synovium; over 50 years of age; rheumatoid factor less than 1:40 titer (agglutination method); synovial fluid signs (clear fluid of normal viscosity and WBC less than 2000/mm3).; Initial approval — B. The member has knee pain which interferes with functional activities (e.g., ambulation, prolonged standing).; Initial approval — C. The member has experienced an inadequate response or adverse effects with non-pharmacologic treatment options (e.g., physical therapy, regular exercise, insoles, knee bracing, weight reduction).; Initial approval — D. The member has experienced an inadequate response or intolerance, or has a contraindication, to a trial of an analgesic (e.g., acetaminophen up to 3 to 4 grams per day, NSAIDs, topical capsaicin cream) for at least 3 months.; Initial approval — E. The member has experienced an inadequate response or intolerance, or has a contraindication, to a trial of intra-articular steroid injections for at least 3 months.; Initial approval — F. The member is not scheduled to undergo a total knee replacement within 6 months of starting treatment.; Continuation of therapy is medically necessary when ALL of the following are met: (1) member meets all initial approval criteria; (2) member has experienced improvement in pain and functional capacity following the previous injections; AND (3) at least 6 months has elapsed since the last injection in the prior completed series of injections.; Approved product — Durolane (hyaluronic acid): single 3 mL injection.; Approved product — Euflexxa (1% sodium hyaluronate): 3 injections, one week apart.; Approved product — Gel-One (cross-linked hyaluronate): single 30 mg injection.; Approved product — Gelsyn-3 (0.84% sodium hyaluronate): 3 injections, one week apart.; Approved product — GenVisc 850 (sodium hyaluronate): 5 injections, one week apart.; Approved product — Hyalgan (sodium hyaluronate): 5 injections, one week apart.; Approved product — Hymovis (high molecular weight hyaluronan): 2 injections, one week apart.; Approved product — Hymovis One (viscoelastic hydrogel): single 4 mL injection.; Approved product — Monovisc (high molecular weight hyaluronan): single 88 mg injection.; Approved product — Orthovisc (high molecular weight hyaluronan): 3-4 injections, one week apart.; Approved product — Supartz FX (sodium hyaluronate): 5 injections, one week apart.; Approved product — Synojoynt (sodium hyaluronate): 3 injections, one week apart.; Approved product — Synvisc (Hylan G-F 20): 3 injections, one week apart.; Approved product — Synvisc One (Hylan G-F 20): single 48 mg injection.; Approved product — Triluron (sodium hyaluronate): 3 injections, one week apart.; Approved product — TriVisc (sodium hyaluronate): 3 injections, one week apart.; Approved product — Visco-3 (sodium hyaluronate): 3 injections, one week apart.; Administration of local anesthetic to anesthetize the injection site for viscosupplementation is considered medically necessary (this is the stated exception to the otherwise non-covered viscosupplementation-with-anesthetic combination).. Applies to 10 codes: 20610, 20611, J7321, J7322, J7323, J7324, J7325, J7326, J7327, J7328.
Action
Confirm prior-authorization status with Aetna before scheduling — it is code- and plan-specific, and this policy is not an exact authorization source. Prior authorization status is code-specific; this CPB is not an exact authorization source for every covered code. Check the Aetna precertification list or PA lookup for the exact code and plan context. Documentation: For Statement of Medical Necessity (SMN) precertification forms, see Specialty Pharmacy Precertification.; Radiographic evidence of knee osteoarthritis (joint space narrowing, subchondral sclerosis, osteophytes, subchondral cysts) OR clinical signs/symptoms (at least 5 of 9 listed criteria).; Documentation of inadequate response or adverse effects with non-pharmacologic treatment (e.g., physical therapy, regular exercise, insoles, knee bracing, weight reduction).; Documentation of inadequate response, intolerance, or contraindication to a trial of an analgesic (acetaminophen, NSAIDs, topical capsaicin) for at least 3 months.; Documentation of inadequate response, intolerance, or contraindication to a trial of intra-articular steroid injections for at least 3 months.; Documentation of knee pain that interferes with functional activities (e.g., ambulation, prolonged standing).
Trap
Policy exclusions and limitations: Intra-articular polynucleotides in the treatment of knee osteoarthritis — considered NOT medically necessary.; Fluoroscopic guidance and knee arthrography for viscosupplement injections — considered NOT medically necessary.; Viscosupplementation in combination with anesthetics, corticosteroids, mannitol/sorbitol, mesenchymal stem cells, or platelet rich plasma — considered NOT medically necessary (EXCEPTION: administration of local anesthetic to anesthetize the injection site for viscosupplementation is considered medically necessary).; Amobarbital / hyaluronic acid hydrogel for post-traumatic osteoarthritis (OA) prevention — considered NOT medically necessary.; Intra-articular injection of a hexadecylamide derivative of hyaluronic acid for the treatment of femoro-acetabular impingement — considered NOT medically necessary.; Viscosupplementation for joints other than the knee — NOT medically necessary, including: ankle, carpo-metacarpal joint, elbow, hip, metatarso-phalangeal joint, shoulder, thumb, and temporomandibular joint (TMJ).; Viscosupplementation for chondromalacia patellae — NOT medically necessary.; Viscosupplementation for facet joint arthropathy — NOT medically necessary.; Viscosupplementation following anterior cruciate ligament (ACL) reconstruction — NOT medically necessary.; Viscosupplementation following arthroscopic knee surgery / partial meniscectomy — NOT medically necessary.; Viscosupplementation for hemophilic arthropathy — NOT medically necessary.; Viscosupplementation for meniscectomy — NOT medically necessary.; Viscosupplementation for muscle stiffness — NOT medically necessary.; Viscosupplementation for osteochondritis dissecans — NOT medically necessary.; Viscosupplementation for palindromic rheumatism — NOT medically necessary.; Viscosupplementation for partial or total knee arthroplasty — NOT medically necessary.; Viscosupplementation for patellofemoral arthritis — NOT medically necessary (specifically NOT covered even within knee OA diagnosis codes).; Viscosupplementation for patellofemoral syndrome (patellar knee pain) — NOT medically necessary.; Viscosupplementation for peripheral nerve pain — NOT medically necessary.; Viscosupplementation for plantar nerve entrapment syndrome — NOT medically necessary.; Viscosupplementation for psoriatic arthritis — NOT medically necessary.; Viscosupplementation for spastic hemiparesis — NOT medically necessary.; Viscosupplementation for treatment of first metatarsophalangeal osteoarthritis (hallux rigidus) — NOT medically necessary. Claims may be denied when the requested service falls under these.

Source: Aetna CPB 0179 — Viscosupplementation for Osteoarthritis

Coverage criteria

  • Viscosupplementation (hyaluronates) is medically necessary for treatment of osteoarthritis (OA) in the KNEE ONLY when ALL of the criteria for initial approval below are met (joints other than the knee are NOT covered).
  • Initial approval (ALL of A-F required) — A. Diagnosis supported by EITHER (ONE of): (1) radiographic evidence of osteoarthritis of the knee (joint space narrowing, subchondral sclerosis, osteophytes, subchondral cysts); OR (2) at least 5 of these 9 signs/symptoms: bony enlargement; bony tenderness; crepitus on active motion; ESR less than 40 mm/hr; less than 30 minutes of morning stiffness; no palpable warmth of synovium; over 50 years of age; rheumatoid factor less than 1:40 titer (agglutination method); synovial fluid signs (clear fluid of normal viscosity and WBC less than 2000/mm3).
  • Initial approval — B. The member has knee pain which interferes with functional activities (e.g., ambulation, prolonged standing).
  • Initial approval — C. The member has experienced an inadequate response or adverse effects with non-pharmacologic treatment options (e.g., physical therapy, regular exercise, insoles, knee bracing, weight reduction).
  • Initial approval — D. The member has experienced an inadequate response or intolerance, or has a contraindication, to a trial of an analgesic (e.g., acetaminophen up to 3 to 4 grams per day, NSAIDs, topical capsaicin cream) for at least 3 months.
  • Initial approval — E. The member has experienced an inadequate response or intolerance, or has a contraindication, to a trial of intra-articular steroid injections for at least 3 months.
  • Initial approval — F. The member is not scheduled to undergo a total knee replacement within 6 months of starting treatment.
  • Continuation of therapy is medically necessary when ALL of the following are met: (1) member meets all initial approval criteria; (2) member has experienced improvement in pain and functional capacity following the previous injections; AND (3) at least 6 months has elapsed since the last injection in the prior completed series of injections.
  • Approved product — Durolane (hyaluronic acid): single 3 mL injection.
  • Approved product — Euflexxa (1% sodium hyaluronate): 3 injections, one week apart.
  • Approved product — Gel-One (cross-linked hyaluronate): single 30 mg injection.
  • Approved product — Gelsyn-3 (0.84% sodium hyaluronate): 3 injections, one week apart.
  • Approved product — GenVisc 850 (sodium hyaluronate): 5 injections, one week apart.
  • Approved product — Hyalgan (sodium hyaluronate): 5 injections, one week apart.
  • Approved product — Hymovis (high molecular weight hyaluronan): 2 injections, one week apart.
  • Approved product — Hymovis One (viscoelastic hydrogel): single 4 mL injection.
  • Approved product — Monovisc (high molecular weight hyaluronan): single 88 mg injection.
  • Approved product — Orthovisc (high molecular weight hyaluronan): 3-4 injections, one week apart.
  • Approved product — Supartz FX (sodium hyaluronate): 5 injections, one week apart.
  • Approved product — Synojoynt (sodium hyaluronate): 3 injections, one week apart.
  • Approved product — Synvisc (Hylan G-F 20): 3 injections, one week apart.
  • Approved product — Synvisc One (Hylan G-F 20): single 48 mg injection.
  • Approved product — Triluron (sodium hyaluronate): 3 injections, one week apart.
  • Approved product — TriVisc (sodium hyaluronate): 3 injections, one week apart.
  • Approved product — Visco-3 (sodium hyaluronate): 3 injections, one week apart.
  • Administration of local anesthetic to anesthetize the injection site for viscosupplementation is considered medically necessary (this is the stated exception to the otherwise non-covered viscosupplementation-with-anesthetic combination).

Covered codes

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

Documentation required

  • For Statement of Medical Necessity (SMN) precertification forms, see Specialty Pharmacy Precertification.
  • Radiographic evidence of knee osteoarthritis (joint space narrowing, subchondral sclerosis, osteophytes, subchondral cysts) OR clinical signs/symptoms (at least 5 of 9 listed criteria).
  • Documentation of inadequate response or adverse effects with non-pharmacologic treatment (e.g., physical therapy, regular exercise, insoles, knee bracing, weight reduction).
  • Documentation of inadequate response, intolerance, or contraindication to a trial of an analgesic (acetaminophen, NSAIDs, topical capsaicin) for at least 3 months.
  • Documentation of inadequate response, intolerance, or contraindication to a trial of intra-articular steroid injections for at least 3 months.
  • Documentation of knee pain that interferes with functional activities (e.g., ambulation, prolonged standing).

Frequently asked questions

When does Aetna cover Viscosupplementation for Osteoarthritis (CPT 20610), and what gets it denied?
Aetna covers viscosupplementation (hyaluronate injections) only for knee osteoarthritis, and only when the member has documented OA (radiographic evidence or at least 5 of 9 clinical signs), pain interfering with function, and has failed or cannot tolerate non-drug therapy plus at least a 3-month trial each of analgesics and intra-articular steroids, with no total knee replacement scheduled within 6 months. Use in any other joint (hip, ankle, shoulder, TMJ, etc.) or for other conditions, and combination with corticosteroids/PRP/stem cells, is considered not medically necessary; precertification is explicitly required. Coverage criteria include: Viscosupplementation (hyaluronates) is medically necessary for treatment of osteoarthritis (OA) in the KNEE ONLY when ALL of the criteria for initial approval below are met (joints other than the knee are NOT covered).; Initial approval (ALL of A-F required) — A. Diagnosis supported by EITHER (ONE of): (1) radiographic evidence of osteoarthritis of the knee (joint space narrowing, subchondral sclerosis, osteophytes, subchondral cysts); OR (2) at least 5 of these 9 signs/symptoms: bony enlargement; bony tenderness; crepitus on active motion; ESR less than 40 mm/hr; less than 30 minutes of morning stiffness; no palpable warmth of synovium; over 50 years of age; rheumatoid factor less than 1:40 titer (agglutination method); synovial fluid signs (clear fluid of normal viscosity and WBC less than 2000/mm3).; Initial approval — B. The member has knee pain which interferes with functional activities (e.g., ambulation, prolonged standing).; Initial approval — C. The member has experienced an inadequate response or adverse effects with non-pharmacologic treatment options (e.g., physical therapy, regular exercise, insoles, knee bracing, weight reduction).; Initial approval — D. The member has experienced an inadequate response or intolerance, or has a contraindication, to a trial of an analgesic (e.g., acetaminophen up to 3 to 4 grams per day, NSAIDs, topical capsaicin cream) for at least 3 months.; Initial approval — E. The member has experienced an inadequate response or intolerance, or has a contraindication, to a trial of intra-articular steroid injections for at least 3 months.; Initial approval — F. The member is not scheduled to undergo a total knee replacement within 6 months of starting treatment.; Continuation of therapy is medically necessary when ALL of the following are met: (1) member meets all initial approval criteria; (2) member has experienced improvement in pain and functional capacity following the previous injections; AND (3) at least 6 months has elapsed since the last injection in the prior completed series of injections.; Approved product — Durolane (hyaluronic acid): single 3 mL injection.; Approved product — Euflexxa (1% sodium hyaluronate): 3 injections, one week apart.; Approved product — Gel-One (cross-linked hyaluronate): single 30 mg injection.; Approved product — Gelsyn-3 (0.84% sodium hyaluronate): 3 injections, one week apart.; Approved product — GenVisc 850 (sodium hyaluronate): 5 injections, one week apart.; Approved product — Hyalgan (sodium hyaluronate): 5 injections, one week apart.; Approved product — Hymovis (high molecular weight hyaluronan): 2 injections, one week apart.; Approved product — Hymovis One (viscoelastic hydrogel): single 4 mL injection.; Approved product — Monovisc (high molecular weight hyaluronan): single 88 mg injection.; Approved product — Orthovisc (high molecular weight hyaluronan): 3-4 injections, one week apart.; Approved product — Supartz FX (sodium hyaluronate): 5 injections, one week apart.; Approved product — Synojoynt (sodium hyaluronate): 3 injections, one week apart.; Approved product — Synvisc (Hylan G-F 20): 3 injections, one week apart.; Approved product — Synvisc One (Hylan G-F 20): single 48 mg injection.; Approved product — Triluron (sodium hyaluronate): 3 injections, one week apart.; Approved product — TriVisc (sodium hyaluronate): 3 injections, one week apart.; Approved product — Visco-3 (sodium hyaluronate): 3 injections, one week apart.; Administration of local anesthetic to anesthetize the injection site for viscosupplementation is considered medically necessary (this is the stated exception to the otherwise non-covered viscosupplementation-with-anesthetic combination).. Applies to 10 codes: 20610, 20611, J7321, J7322, J7323, J7324, J7325, J7326, J7327, J7328. Confirm prior-authorization status with Aetna before scheduling — it is code- and plan-specific, and this policy is not an exact authorization source. Prior authorization status is code-specific; this CPB is not an exact authorization source for every covered code. Check the Aetna precertification list or PA lookup for the exact code and plan context. Documentation: For Statement of Medical Necessity (SMN) precertification forms, see Specialty Pharmacy Precertification.; Radiographic evidence of knee osteoarthritis (joint space narrowing, subchondral sclerosis, osteophytes, subchondral cysts) OR clinical signs/symptoms (at least 5 of 9 listed criteria).; Documentation of inadequate response or adverse effects with non-pharmacologic treatment (e.g., physical therapy, regular exercise, insoles, knee bracing, weight reduction).; Documentation of inadequate response, intolerance, or contraindication to a trial of an analgesic (acetaminophen, NSAIDs, topical capsaicin) for at least 3 months.; Documentation of inadequate response, intolerance, or contraindication to a trial of intra-articular steroid injections for at least 3 months.; Documentation of knee pain that interferes with functional activities (e.g., ambulation, prolonged standing). Policy exclusions and limitations: Intra-articular polynucleotides in the treatment of knee osteoarthritis — considered NOT medically necessary.; Fluoroscopic guidance and knee arthrography for viscosupplement injections — considered NOT medically necessary.; Viscosupplementation in combination with anesthetics, corticosteroids, mannitol/sorbitol, mesenchymal stem cells, or platelet rich plasma — considered NOT medically necessary (EXCEPTION: administration of local anesthetic to anesthetize the injection site for viscosupplementation is considered medically necessary).; Amobarbital / hyaluronic acid hydrogel for post-traumatic osteoarthritis (OA) prevention — considered NOT medically necessary.; Intra-articular injection of a hexadecylamide derivative of hyaluronic acid for the treatment of femoro-acetabular impingement — considered NOT medically necessary.; Viscosupplementation for joints other than the knee — NOT medically necessary, including: ankle, carpo-metacarpal joint, elbow, hip, metatarso-phalangeal joint, shoulder, thumb, and temporomandibular joint (TMJ).; Viscosupplementation for chondromalacia patellae — NOT medically necessary.; Viscosupplementation for facet joint arthropathy — NOT medically necessary.; Viscosupplementation following anterior cruciate ligament (ACL) reconstruction — NOT medically necessary.; Viscosupplementation following arthroscopic knee surgery / partial meniscectomy — NOT medically necessary.; Viscosupplementation for hemophilic arthropathy — NOT medically necessary.; Viscosupplementation for meniscectomy — NOT medically necessary.; Viscosupplementation for muscle stiffness — NOT medically necessary.; Viscosupplementation for osteochondritis dissecans — NOT medically necessary.; Viscosupplementation for palindromic rheumatism — NOT medically necessary.; Viscosupplementation for partial or total knee arthroplasty — NOT medically necessary.; Viscosupplementation for patellofemoral arthritis — NOT medically necessary (specifically NOT covered even within knee OA diagnosis codes).; Viscosupplementation for patellofemoral syndrome (patellar knee pain) — NOT medically necessary.; Viscosupplementation for peripheral nerve pain — NOT medically necessary.; Viscosupplementation for plantar nerve entrapment syndrome — NOT medically necessary.; Viscosupplementation for psoriatic arthritis — NOT medically necessary.; Viscosupplementation for spastic hemiparesis — NOT medically necessary.; Viscosupplementation for treatment of first metatarsophalangeal osteoarthritis (hallux rigidus) — NOT medically necessary. Claims may be denied when the requested service falls under these.
Does Aetna require prior authorization for Viscosupplementation for Osteoarthritis?
Confirm prior-authorization status with Aetna before scheduling — it is code- and plan-specific, and this policy is not an exact authorization source. Prior authorization status is code-specific; this CPB is not an exact authorization source for every covered code. Check the Aetna precertification list or PA lookup for the exact code and plan context. Documentation: For Statement of Medical Necessity (SMN) precertification forms, see Specialty Pharmacy Precertification.; Radiographic evidence of knee osteoarthritis (joint space narrowing, subchondral sclerosis, osteophytes, subchondral cysts) OR clinical signs/symptoms (at least 5 of 9 listed criteria).; Documentation of inadequate response or adverse effects with non-pharmacologic treatment (e.g., physical therapy, regular exercise, insoles, knee bracing, weight reduction).; Documentation of inadequate response, intolerance, or contraindication to a trial of an analgesic (acetaminophen, NSAIDs, topical capsaicin) for at least 3 months.; Documentation of inadequate response, intolerance, or contraindication to a trial of intra-articular steroid injections for at least 3 months.; Documentation of knee pain that interferes with functional activities (e.g., ambulation, prolonged standing).
What does Aetna exclude for Viscosupplementation for Osteoarthritis?
Policy exclusions and limitations: Intra-articular polynucleotides in the treatment of knee osteoarthritis — considered NOT medically necessary.; Fluoroscopic guidance and knee arthrography for viscosupplement injections — considered NOT medically necessary.; Viscosupplementation in combination with anesthetics, corticosteroids, mannitol/sorbitol, mesenchymal stem cells, or platelet rich plasma — considered NOT medically necessary (EXCEPTION: administration of local anesthetic to anesthetize the injection site for viscosupplementation is considered medically necessary).; Amobarbital / hyaluronic acid hydrogel for post-traumatic osteoarthritis (OA) prevention — considered NOT medically necessary.; Intra-articular injection of a hexadecylamide derivative of hyaluronic acid for the treatment of femoro-acetabular impingement — considered NOT medically necessary.; Viscosupplementation for joints other than the knee — NOT medically necessary, including: ankle, carpo-metacarpal joint, elbow, hip, metatarso-phalangeal joint, shoulder, thumb, and temporomandibular joint (TMJ).; Viscosupplementation for chondromalacia patellae — NOT medically necessary.; Viscosupplementation for facet joint arthropathy — NOT medically necessary.; Viscosupplementation following anterior cruciate ligament (ACL) reconstruction — NOT medically necessary.; Viscosupplementation following arthroscopic knee surgery / partial meniscectomy — NOT medically necessary.; Viscosupplementation for hemophilic arthropathy — NOT medically necessary.; Viscosupplementation for meniscectomy — NOT medically necessary.; Viscosupplementation for muscle stiffness — NOT medically necessary.; Viscosupplementation for osteochondritis dissecans — NOT medically necessary.; Viscosupplementation for palindromic rheumatism — NOT medically necessary.; Viscosupplementation for partial or total knee arthroplasty — NOT medically necessary.; Viscosupplementation for patellofemoral arthritis — NOT medically necessary (specifically NOT covered even within knee OA diagnosis codes).; Viscosupplementation for patellofemoral syndrome (patellar knee pain) — NOT medically necessary.; Viscosupplementation for peripheral nerve pain — NOT medically necessary.; Viscosupplementation for plantar nerve entrapment syndrome — NOT medically necessary.; Viscosupplementation for psoriatic arthritis — NOT medically necessary.; Viscosupplementation for spastic hemiparesis — NOT medically necessary.; Viscosupplementation for treatment of first metatarsophalangeal osteoarthritis (hallux rigidus) — NOT medically necessary. Claims may be denied when the requested service falls under these.

Source

Aetna CPB 0179 — Viscosupplementation for Osteoarthritis

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Coverage disclaimer

This page summarizes Aetna clinical-coverage criteria extracted from policy CPB 0179 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.