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:
* 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||Immune globulins [intramuscular, intravenous, subcutaneous]|
|90465 - 90466, 90468 - 90472, 90474||Immunization administration for vaccines/toxoids [intradermal, intramuscular, percutaneous, subcutaneous]|
|90581 - 90676, 90691 - 90710, 90713 - 90749||Vaccines, toxoids [intradermal, intramuscular, intravesicular, percutaneous, subcutaneous]|
|96365-96379||Therapeutic, prophylactic, and diagnostic injections and infusions|
|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]|