Skip to main content

Medical clinical policy bulletins

Using Clinical Policy Bulletins to determine medical coverage

Using Clinical Policy Bulletins to determine medical coverage

Medical Clinical Policy Bulletins (CPBs) detail the services and procedures we consider medically necessary, cosmetic, or experimental and unproven. They help us decide what we will and will not cover. CPBs are based on:

 

  • Peer-reviewed, published medical journals
  • A review of available studies on a particular topic
  • Evidence-based consensus statements
  • Expert opinions of health care professionals
  • Guidelines from nationally recognized health care organizations

 

Attention Pennsylvania Medicaid providers

 

We have different CPBs for Pennsylvania Medicaid. They are not available through search. Instead, use the link below.

 

Pennsylvania Medicaid CPBs

 

Attention reformatted CPBs

 

A new format for 61 select CPBs will be implemented in 2022: This updated format includes a Table of Contents with links, a new Policy section format segmented by medical necessity, experimental and investigational, and cosmetic, and a new Glossary of Terms section. The reformatted CPBs will be released in three phases, starting with 22 CPBs updated in mid-February. The list of reformatted CPBs will be found in the “What’s New” section below.

Search by keyword

 

Enter your keyword or 4-digit CPB number (for example, enter 0059 to find CPB 59) to find related medical clinical policy bulletins.

Additions, revisions, updates, and deletions sorted by date

Loading, please wait

Search alphabetical and category

Loading, please wait

Changes to review schedule

 

Please note that the information below sets forth the anticipated schedule for review of the specified Clinical Policy Bulletin (CPB) in the ordinary course. This schedule is subject to change based on various factors, including but not limited to intervening clinical developments and available resources. Aetna does not hereby commit to review any specific CPB by a specific date, and expressly reserves the right to change any CPB without notice. Aetna does not hereby assume any obligation to update information presented in the below schedule, so information contained herein may be out of date at any given time.

 

The CPB review dates below are the anticipated start dates of the CPB review process for each CPB listed. The “Last Review” date appearing on the CPB is the date the review is completed and the CPB is published.

Loading, please wait

Legal notices

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).

Health benefits and health insurance plans contain exclusions and limitations.