Guidelines for Determining Coverage | Clinical Policy Bulletins | Medicare | Payment Policy
Aetna’s Medical Clinical Policy Bulletins (CPBs) state Aetna’s policy regarding the experimental and investigational status and medical necessity of medical technologies and other services for the purposes of making coverage decisions under Aetna administered health benefit plans. In making coverage decisions, Aetna's professional staff refer to the member's plan of benefits, and if necessary, the CPBs and other Aetna-recognized criteria.
Aetna’s CPBs are based on evidence in the peer-reviewed published medical literature, technology assessments and structured evidence reviews, evidence-based consensus statements, expert opinions of healthcare providers, and evidence-based guidelines from nationally recognized professional healthcare organizations and public health agencies.
The CPBs can be highly technical. Members and consumers should review the information in the CPBs with their doctors so that they may more fully understand them.
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