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Aetna Aetna
Clinical Policy Bulletin:
Injectable Medications
Number: 0020


Policy

Notes: Aetna covers injectable medications when an appropriate oral alternative drug does not exist.  This coverage includes those medications intended to be self-administered.  The medication must be medically necessary and appropriate to the member's needs or condition.

Experimental or investigational drugs or drugs that have not been proven safe and effective for a specific disease or approved for a mode of treatment by the Food and Drug Administration (FDA) and/or the National Institutes of Health are not covered.  This provision does not exclude coverage of established “off label” uses of otherwise FDA-approved prescribed medications.

Drugs related to the treatment of non-covered services are not covered.  Infertility injectable medications are covered only when required by regulation or covered by a specific benefit design.  Steroids are not covered for the enhancement of performance, as this is not considered treatment of disease.

Note: Some state-to-state and plan type variations exist.

Certain classes of injectable medications are excluded from coverage under some benefit plans.  Please check benefit plan descriptions for details:

  1. Anabolic steroids when used for performance enhancement (also see CPB 0528 - Androgens and Anabolic Steroids)
  2. Contraceptive injectable medications.** (also see CPB 0510 - Progestins)
  3. Immunizations for travel (also see CPB 0473 - Vaccines for Travel)
  4. Infertility injectable medications* (also see CPB 0327 - Infertility)

* Exception: Infertility injectable medications are covered only when required by regulation or covered by a specific benefit design.

**Contraceptive injectable medications are covered under plans with the contraceptives rider or under plans with a contraceptives benefit.



 
CPT Codes / HCPCS Codes / ICD-9 Codes
Other CPT codes related to the CPB:
90281 - 90399
90465 - 90466, 90468 - 90472, 90474
90581 - 90676, 90691 - 90710, 90713 - 90749
96365-96379
Other HCPCS codes related to the CPB:
A4737, A9543, A9545, A9563, A9564, A9600 - A9605, A9699, C8957 - C9235, G0008 - G0010, G0260, G0332, G3001, J0120 - J0270, J0278 - J2543, J2550 - J3520, J3570 - J3590, J7187 - J7199, J7319, J9000 - J9999, Q0081 - Q0085, Q0515, Q2009 - Q2017, Q3027, Q4079, Q4081 - Q4086, S0017 -S0081, S0091 - S0093, S0122 - S0132, S0145 - S0156, S0162 - S0167, S0171, S0195, S5550 - S5553 Injectable medications and administration [intramuscular, intrathecal, intravenous, subcutaneous]


The above policy is based on the following references:
  1. AHFS Drug Information. Bethesda, MD: American Society of Health-System Pharmacists; Updated periodically.
  2. Physicians' Desk Reference (PDR). Montvale, NJ: Thomson PDR; Updated periodically.
  3. NCCN Drug and Biologics Compendium. Fort Washington, PA: National Comprehensive Cancer Network (NCCN); Updated periodically.
  4. DRUGDEX System [Internet database]. Greenwood Village, CO: Thomson Micromedex. Updated periodically.
  5. Clinical Pharmacology. Tampa,, FL: Gold Standard/Elsevier; Updated periodically.


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Copyright Aetna Inc. All rights reserved. Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Treating providers are solely responsible for medical advice and treatment of members. This Clinical Policy Bulletin may be updated and therefore is subject to change.
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