Includes PPO, HMO, HMO-POS medical plans with or without drugs. 7 days a week, 24 hours a day. The five character codes included in the Aetna Clinical Policy Bulletins (CPBs) are obtained from Current Procedural Terminology (CPT), copyright 2015 by the American Medical Association (AMA). The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna) for a particular member. Treating providers are solely responsible for medical advice and treatment of members. The majority of Aetna Medicare plan members are in a plan rated 4.5 stars or higher out of 5 stars. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements. Treating providers are solely responsible for medical advice and treatment of members. Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna). The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. CPT only copyright 2015 American Medical Association. Want to see options for a different location? All fields marked with an asterisk (*) are required. Your InstaMed log in may be different from your Caremark.com secure member site log in. With our virtual care and telemedicine options, you can talk to a doctor by phone 24/7. The home visits conducted by Medicare Advantage plans allow for the capture of more diagnoses, which in turn increases the risk score that adjusts plan payments from Medicare. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. Or simply go to our Get Started page. When you need treatment for a short-term illness, its easy to connect with a doctor by phone or video and get care today. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. While Clinical Policy Bulletins (CPBs) define Aetna's clinical policy, medical necessity determinations in connection with coverage decisions are made on a case by case basis. In case of a conflict between your plan documents and this information, the plan documents will govern. And Medicare will never call out of the blue to say youll lose Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. Go to the American Medical Association Web site. Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna). Our plan selection pages will be down for maintenance starting Friday, April 16, at 9 p.m. and returning by 1 p.m. Saturday, April 17. The responsibility for the content of Aetna Precertification Code Search Tool is with Aetna and no endorsement by the AMA is intended or should be implied. WebTelehealth Services for Aetna Members Care anytime, anywhere With our virtual care and telemedicine options, you can talk to a doctor by phone 24/7. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. This search will use the five-tier subtype. *Last Name. The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. Your Payer Express log in may be different from your Aetna secure member site log in. Aetna handles premium payments through InstaMed, a trusted payment service. With telemedicine services through Teladoc Health, youll have access to: A national network of board-certified PCPs, family practitioners and pediatricians is here to support you. Applicable FARS/DFARS apply. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. This site has its own log in. Just enter your mobile number and well text you a link to download the Aetna Health app from the App Store or on Google Play. All Rights Reserved. CPT is developed by the AMA as a listing of descriptive terms and five character identifying codes and modifiers for reporting medical services and procedures performed by physicians. Yes, I'm a memberNo, I'm looking for a plan. CPT is developed by the AMA as a listing of descriptive terms and five character identifying codes and modifiers for reporting medical services and procedures performed by physicians. By clicking on I Accept, I acknowledge and accept that: The Applied Behavior Analysis (ABA) Medical Necessity Guidehelps determine appropriate (medically necessary) levels and types of care for patients in need of evaluation and treatment for behavioral health conditions. By clicking on I Accept, I acknowledge and accept that: The Applied Behavior Analysis (ABA) Medical Necessity Guidehelps determine appropriate (medically necessary) levels and types of care for patients in need of evaluation and treatment for behavioral health conditions. You are now being directed to CVS Caremark site. Aetna makes no representations and accepts no liability with respect to the content of any external information cited or relied upon in the Clinical Policy Bulletins (CPBs). Thank you so much. If you do not intend to leave our site, close this message. The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna) for a particular member. Do you want to continue? Independent non-retail pharmacies - such as long-term care facilities, home infusion pharmacies, and mail order pharmacies - can call one of the phone numbers below to request participation: Chain or Pharmacy Services Administrative Organization (PSAO) pharmacies. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. *First Name. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy or privacy practices of linked sites, or for products or services described on these sites. Let us help! While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. The discussion, analysis, conclusions and positions reflected in the Clinical Policy Bulletins (CPBs), including any reference to a specific provider, product, process or service by name, trademark, manufacturer, constitute Aetna's opinion and are made without any intent to defame. Any information we provide is limited to those plans we do offer in your area. [Narrator] Our quality providers are here for you 24/7, 365. CPT is a registered trademark of the American Medical Association. The Dental Clinical Policy Bulletins (DCPBs) describe Aetna's current determinations of whether certain services or supplies are medically necessary, based upon a review of available clinical information. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. We're here to help. Since Dental Clinical Policy Bulletins (DCPBs) can be highly technical and are designed to be used by our professional staff in making clinical determinations in connection with coverage decisions, members should review these Bulletins with their providers so they may fully understand our policies. However, applicable state mandates will take precedence with respect to fully insured plans and self-funded non-ERISA (e.g., government, school boards, church) plans. This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. In addition, a member may have an opportunity for an independent external review of coverage denials based on medical necessity or regarding the experimental and investigational status when the service or supply in question for which the member is financially responsible is $500 or greater. If you do not intend to leave our site, close this message. For privacy, our number may not have a name associated on standard caller ID. While Clinical Policy Bulletins (CPBs) define Aetna's clinical policy, medical necessity determinations in connection with coverage decisions are made on a case by case basis. 1-877-238-6211${tty} No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. [Narrator] And you'll get support for more than just your physical health. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. We know insurance is confusing and you have questions. Links to various non-Aetna sites are provided for your convenience only. In case of a conflict between your plan documents and this information, the plan documents will govern. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. Any use of CPT outside of Aetna Clinical Policy Bulletins (CPBs) should refer to the most current Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. Why choose ${company} Medicare Solutions? Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. For language services, please call the number on your member ID card and request an operator. We'll try our best to get back to you within 24 hours. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Want to see options for a different location? Select a state below to update coverage details. If you do not intend to leave our site, close this message. Select a state below to update coverage details. The responsibility for the content of Aetna Clinical Policy Bulletins (CPBs) is with Aetna and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this product. It's easy to update a provider address, phone number, fax number, email address or initiate an out-of-state move or a change in provider group. 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