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Dental plans made for you

Aetna Dental® Direct insurance plans help keep your smile healthy — and your wallet happy — with preventive services covered at 100%. Explore more choices, savings and convenient options to care for your whole health.

 

Ready to find dental plans and providers near you?

This content is pending approval in DE, ID, OK, UT and WV.

Benefits included in every planProtect your smile and your budget

  • Dental coverage that starts working on day 1

     
    • Preventive care covered at 100%, including dental checkups, cleanings and X-rays
    • Access to fillings, crowns, root canals and more
    • Plan options starting at $17 a month

    Day 1 terms*

  • A dentist you know and trust, close to home

    • Access to thousands of in-network dental providers
    • Quick care lookup — enter your ZIP code in our “Find a dental plan” box to search for providers near you. 

  • Extra perks to save time and money

Dental plans at a glanceLooking for a plan that fits your life and budget? Let’s explore.

We can help you find the right dental plan for you and your family. Use this chart to compare in-network covered services* and costs. (State laws vary for out-of-network benefits.*)

PlanAnnual benefit maximum*Preventive services*Basic services*Major services*Deductible*Monthly cost*Plan summary
Aetna Dental® Direct Preferred 2000 PPO$2,000$0 (no deductible)You pay 20%*You pay 50%*


$50 (individual) 

 

$150
(family)

Starting at $29 a monthChoice of any provider and covers up to $2,000 after meeting the deductible and coinsurance 
Aetna Dental® Direct Preferred PPO$1,250$0 (no deductible)You pay 20%*You pay 50%*

$50 (individual) 

 

$150
(family)

Starting at $26 a monthSame as the Preferred 2000 plan with choice of any provider, but pays up to $1,250 after meeting the deductible and coinsurance 
Aetna Dental® Direct Core PPO$1,000$0 (no deductible)You pay 50%*You pay 50%*

$50 (individual) 

 

$150
(family)

Starting at $22 a monthSimilar to the Preferred plan with a lower premium, but you may pay more for services
Aetna Dental® Direct DMO®No maximumCopay varies per service*Copay varies per service*Copay varies per service*$0 (no deductible)Starting at $17 a monthBudget-conscious coverage for routine care with the lowest  monthly premium cost
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“We are very pleased with our choice of having Aetna insurance. Having dental and eye insurance with Aetna is a wonderful benefit. Our other insurance didn't have these benefits.” 

 

— Aetna member

 

More reasons to smile

Aetna® Vital Savings discounts

Looking for an alternative to dental insurance? You can get instant savings off the cost of most dental services.

Oral health tips for overall health

Routine dental care helps keep your mouth healthy. Did you know it can help spot many medical conditions, too?

Aetna dental insurance FAQsYour questions answered

  • Think of dental insurance as your ally in maintaining a healthy smile. It's health coverage that's built for dental care. It helps handle a portion of your costs for everything from routine cleanings to complex treatments. This means you'll pay less out of pocket when you visit the dentist. 

  • After you enroll in a dental plan, you’ll pay a monthly premium to keep your coverage active. Most plans include a deductible. That's the amount you pay before your insurance benefits begin to cover services. Once you’ve met your deductible, it’s common to share costs with the plan through copays or coinsurance. How you share costs depends on your plan.

  • Your coverage includes three levels of care: 

     

    • Preventive services. Cleanings, X-rays, and routine exams 
    • Basic procedures. Fillings, simple extractions and essential restorative treatments 
    • Major treatments. Bridges, crowns, dentures, root canals and other major procedures 

    Some services may have age restrictions or limits on use. 

     

    Here's great news: 

     

    • You can use your dental benefits right away. Your preventive care benefits start as soon as you enroll.
    • There are no waiting periods. If you or your family members kept up continuous dental coverage within 90 days of enrolling, there are no waiting periods for basic or major services. 

    Be sure to review your plan policy to understand your benefits and coverage. 

  • A waiting period is a time frame between when you buy coverage and when your benefits become available. That’s why planning ahead matters. If you wait until you need extensive dental work, you might have a 6 to 12 month wait for full coverage on all procedures. 

     

    Some things to keep in mind: 

     

    • Waiting periods vary by plan.
    • Waiting periods often apply to basic and major procedures with PPO insurance. 
    • There are no waiting periods for preventive care like cleanings and checkups. You can get these services right away. 

    Good news: If you've had recent dental coverage, we may waive the waiting period. Just provide proof of your prior insurance. 

  • Yes. Aetna Dental Direct PPO plans give you the freedom to visit any dentist who accepts your insurance. With over 600,000 dentist locations* in the Aetna Dental PPO network, finding quality care close to home is simple. Staying in network can also maximize your savings.

  • The Aetna Dental Direct DMO plan is a budget-friendly plan that helps you access routine and preventive care at a lower cost. This plan requires you to choose a provider in our network. As you’re exploring this plan, you can search for providers and find one near you.

  • The Aetna Dental Direct PPO and DMO plans include online tools to help you take charge of your dental benefits and care. You can use your member account to check benefits, track claims, find in-network providers and more. These tools help make your experience seamless and straightforward.

  • Yes. You can use Aetna dental plans alongside other dental insurance you may have. We’ll work with your other insurer to determine what each plan covers. This is called coordination of benefits. And it could lower what you pay. Be sure to check that your other plan allows coordination of benefits.

  • Visit our directory of dental care professionals for the most up-to-date list of providers. Our network is always evolving. So, it’s a great idea to call your chosen dentist before your visit to check coverage. You can also call our team at 1-855-837-6453 ${tty} for help.

  • Your plan offers added value for members with extras that go beyond dental coverage. 

     

    Your membership includes: 

     

    • Virtual dental care through Dental.com for emergencies and preventive screenings
    • CVS ExtraCare Plus for special savings on health and wellness essentials and convenient access to medicine and health products

    More ExtraCare Plus benefits: 

     

    • Shipping: Enjoy complimentary 1- to 2-day  shipping from CVS.com 

    • Support: Connect with a pharmacist anytime with our 24/7 helpline 

For day 1 terms

All members on the plan must have been continuously enrolled in a dental plan for a period of 90 days prior to this coverage to waive the waiting period in preferred provider organization (PPO) plans.

For CVS® ExtraCare Plus® membership terms

Requires registration through the Aetna Health℠ app or Aetna® member website. Membership will be terminated if you are no longer on an eligible dental plan or if CVS cannot verify your eligibility. No recurring payments or payment data is required to receive or maintain membership. Must have a valid ExtraCare® card to enroll. To cancel, call 1-800-746-7287 ${tty} or cancel online anytime. Bonus rewards are promotional, have no cash value and are not redeemable for cash. To enable certain digital, shipping and pharmacy delivery benefits, you must have a CVS® account and complete your digital profile online. CVS.com® shipping and same-day delivery are FREE for qualifying orders of at least $10 after the application of any coupons, rewards or discounts and before taxes are applied. Visit full terms and conditions at CVS.com/ExtraCare/Plus/Terms.

For $10 monthly reward terms

May take up to 72 hours to load to ExtraCare® card. Bonus reward expires on stated expiration date and cannot be used toward renewal of ExtraCare Plus® membership. Only redeemable on a single transaction at participating CVS Pharmacy® locations or on CVS.com® for eligible merchandise. Minimum of $10 purchase (excluding taxes and fees) for CVS.com purchases. Bonus rewards are promotional, have no cash value, are not redeemable for cash and are not transferrable. We reserve the right to process bonus rewards and coupons in any order. Sales tax may be charged pre-coupon. Bonus rewards and coupons cannot be exchanged for cash or gift card and may not be reissued or prorated for refund. Excludes alcohol, bottle deposits, bus passes, copays, ephedrine/pseudoephedrine products, gift cards, hunting and fishing license, lottery tickets, magazines, milk (where required by law or regulation), money orders, newspapers, postage stamps, prepaid cards, prescriptions, and any imposed governmental fees and items reimbursed by a government health plan. Visit full terms and conditions at CVS.com/ExtraCare/Plus/Terms. ExtraCare Plus is not available in GA, MN, MO, NJ, NY, OK, TX and VA.

For covered services terms

Some covered services have limits based on your age, how often you use them and your past coverage. Once you choose a plan, check your plan documents for your covered services and benefit levels.

For out-of-network benefit details

In Illinois, DMO plans provide limited out-of-network benefits. However, to receive maximum benefits, members must select and have care coordinated by a participating primary care dentist. Illinois DMO is not an HMO.

For preventive services

Examples include routine checkups, cleanings and bitewing X-rays.

For basic services

Examples include fillings, simple extractions and emergency pain relief.

For 20% for basic services

This is the portion you pay for covered in-network dental services after you’ve met your deductible.

For 50% for basic services

This is the portion you pay for covered in-network dental services after you’ve met your deductible.

For major services

Examples include root canals, crowns, dentures and bridges.

For 50% for major services

This is the portion you pay for covered in-network dental services after you’ve met your deductible.

For annual benefit maximum

This is the most your plan will pay for covered in-network dental services per calendar year after meeting deductible and coinsurance.

For deductible

This is the amount you need to pay per calendar year before your plan starts to pay for covered dental services.

For monthly cost

These monthly costs are examples of our lowest monthly rates. Your cost may vary based on the plan you choose and the number of people you cover on your plan. Once you choose a dental plan, check your plan documents for your covered services and benefit levels.

For copay varies by service details

Your out-of-pocket cost depends on the service. Here’s a sample of in-network copays for Aetna Dental Direct DMO:

 

Preventive services

  • Office visit: $5
  • Preventive oral exams: $0
  • Cleanings: $0
  • Full-mouth series images: $0
  • Sealants (permanent molars only): $0

 

Basic services

  • Resin filling (1 surface): $26 to $63
  • Periodontal maintenance cleanings: $65
  • Tooth extraction (simple, primary tooth): $8

 

Major services

  • Impacted tooth removal (soft tissue): $65
  • Crowns: $265 to $362
  • Root canal therapy: $135 to $333
  • Dentures: $174 to $483

 

Orthodontics isn't covered.

 

To find your plan costs, check your plan details.

For over 600,000 dentist locations source

Based on Aetna Dental PPO network data as of July 1, 2026.

For 20% off CVS Health® brand products terms

Excludes sale and promo items, alcohol, prescriptions and copays, pseudoephedrine/ephedrine products, prepaid gift cards and items reimbursed by any health plan. Not combinable with other offers. 20% discount is not valid on other CVS brands such as CVS Pharmacy®, Beauty 360®, CVS, Gold Emblem® or Gold Emblem abound®. CVS reserves the right to apply the 20% discounts to qualifying items in any order within the transaction. For in-store use only.

For free delivery terms

Free Rx delivery is available for qualifying prescription orders and health plans. Delivery times may vary. Most stores are eligible for delivery. Check our store locator to find out if your store is eligible. Other exclusions apply. Visit full terms and conditions at CVS.com/ExtraCare/Plus/Terms.
Customer support

Questions?

To learn about our individual dental plans, call us at 1-855-837-6453 ${tty}. We’re here Monday to Friday, 8 AM to 8 PM ET.

Legal notices

Dental plans and vision benefits are insured by Aetna Life Insurance Company, Aetna Dental Inc. and/or Aetna Health Inc. (Aetna). Certain vision claims administration services are provided by First American Administrators, Inc. and certain network administration services are provided through EyeMed Vision Care ("EyeMed"), LLC. Aetna and CVS are part of the CVS Health family of companies.

This material is for information only and is not an offer or invitation to contract. An application must be completed to obtain coverage. Insurance plans contain exclusions and limitations. See brochure and policy for a complete description of benefits, exclusions, limitations and conditions of coverage. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna does not provide care. Plan features and availability may vary by location and are subject to change. Enter your ZIP code above for more information about Aetna dental plans.

Policy forms issued in Idaho include: AL IVL HPol-PPODental_WP 01 and AL IVL HPol-PPODental_NWP 01.
Policy forms issued in Missouri, Oklahoma, Washington and Wyoming include: AL IVL HPol-PPODental 01.

Aetna Vital Savings (the “Program”) is not insurance. The Program does not meet the Minimum Creditable Coverage requirements in Massachusetts. It provides access to discounted rates offered by participating providers who are independent contractors and not employees or agents of Aetna. The Program does not make any payments to providers. You are responsible for paying the provider but will receive a discount from those providers in our discount program network. Discount amounts may vary depending on the provider and type of service. Provider participation may change without notice. Aetna Vital Savings is not available in Vermont or Montana. Aetna Life Insurance Company, located at 151 Farmington Avenue, Hartford, CT 06156, 1-877-698-4825 ${tty}, is the Discount Plan Organization. AetnaVitalSavings.com

DISCOUNT OFFERS ARE NOT INSURANCE. They are not benefits under your insurance plan. You get access to discounts off the regular charge on products and services offered by third party vendors and providers. Aetna makes no payment to the third parties — you are responsible for the full cost. Check any insurance plan benefits you have before using these discount offers, as those benefits may give you lower costs than these discounts.

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Each main plan type has more than one subtype. Some subtypes have five tiers of coverage. Others have four tiers, three tiers or two tiers. This search will use the five-tier subtype. It will show you whether a drug is covered or not covered, but the tier information may not be the same as it is for your specific plan. Do you want to continue?
 

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Applied Behavior Analysis Medical Necessity Guide

By clicking on “I Accept”, I acknowledge and accept that:
 

The Applied Behavior Analysis (ABA) Medical Necessity Guide helps determine appropriate (medically necessary) levels and types of care for patients in need of evaluation and treatment for behavioral health conditions. The ABA Medical Necessity Guide does not constitute medical advice. Treating providers are solely responsible for medical advice and treatment of members. Members should discuss any matters related to their coverage or condition with their treating provider.

Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. 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.

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. The member's benefit plan determines coverage. Some plans exclude coverage for services or supplies that Aetna considers medically necessary.

Please note also that the ABA Medical Necessity Guide may be updated and are, therefore, subject to change.

Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. In the event that a member disagrees with a coverage determination, member may be eligible for the right to an internal appeal and/or an independent external appeal in accordance with applicable federal or state law.

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Licensee's use and interpretation of the American Society of Addiction Medicine’s ASAM Criteria for Addictive, Substance-Related, and Co-Occurring Conditions does not imply that the American Society of Addiction Medicine has either participated in or concurs with the disposition of a claim for benefits.

 

This excerpt is provided for use in connection with the review of a claim for benefits and may not be reproduced or used for any other purpose.

 

Copyright 2015 by the American Society of Addiction Medicine. Reprinted with permission. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM.

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Precertification lists

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Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept".

 

  • The term precertification here means the utilization review process to determine whether the requested service, procedure, prescription drug or medical device meets the company's clinical criteria for coverage. It does not mean precertification as defined by Texas law, as a reliable representation of payment of care or services to fully insured HMO and PPO members.
  • Applies to: Aetna Choice® POS, Aetna Choice POS II, Aetna Medicare℠ Plan (PPO), Aetna Medicare Plan (HMO), all Aetna HealthFund® products, Aetna Health Network Only℠, Aetna Health Network Option℠, Aetna Open Access® Elect Choice®, Aetna Open Access HMO, Aetna Open Access Managed Choice®, Open Access Aetna Select℠, Elect Choice, HMO, Managed Choice POS, Open Choice®, Quality Point-of-Service® (QPOS®), and Aetna Select℠ benefits plans and all products that may include the Aexcel®, Choose and Save℠, Aetna Performance Network or Savings Plus networks. Not all plans are offered in all service areas.
  • All services deemed "never effective" are excluded from coverage. Aetna defines a service as "never effective" when it is not recognized according to professional standards of safety and effectiveness in the United States for diagnosis, care or treatment. Visit the secure website, available through www.aetna.com, for more information. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search."
  • The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT®), copyright 2025 by the American Medical Association (AMA). 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.
  • 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. The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Aetna Precertification Code Search Tool. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Any use of CPT outside of Aetna Precertification Code Search Tool should refer to the most Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. Applicable FARS/DFARS apply.

 

LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT®")

 

  • CPT only Copyright 2025 American Medical Association. All Rights Reserved. CPT is a registered trademark of the American Medical Association. You, your employees and agents are authorized to use CPT only as contained in Aetna Precertification Code Search Tool solely for your own personal use in directly participating in health care programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to sue CPT for any use not authorized herein must be obtained through the American Medical Association, CPT Intellectual Property Services, 515 N. State Street, Chicago, Illinois 60610. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt.

 

U.S. Government Rights

 

  • 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. 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.

 

Disclaimer of Warranties and Liabilities.

 

  • CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. No fee schedules, basic unit, relative values or related listings are included in CPT. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or 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.
  • This Agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this Agreement.
  • Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept".
  • The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services.
  • This information is neither an offer of coverage nor medical advice. It is only a partial, general description of plan or program benefits and does not constitute a contract. In case of a conflict between your plan documents and this information, the plan documents will govern.
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Dental clinical policy bulletins

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  • Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. Treating providers are solely responsible for dental advice and treatment of members. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider.
  • While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. 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. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. 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. Aetna's 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). Your benefits plan determines coverage. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government.
  • Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change.
  • 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.
  • Under certain plans, if more than one service can be used to treat a covered person's dental condition, Aetna may decide to authorize coverage only for a less costly covered service provided that certain terms are met.
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Medical clinical policy bulletins

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Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept".

 

  • Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. Treating providers are solely responsible for medical advice and treatment of members. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider.
  • While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental, investigational, unproven, or cosmetic. Aetna has reached these conclusions based upon a review of currently available clinical information (including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the technology, evidence-based guidelines of public health and health research agencies, evidence-based guidelines and positions of leading national health professional organizations, views of physicians practicing in relevant clinical areas, and other relevant factors).
  • 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). 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. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error.
  • CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. New and revised codes are added to the CPBs as they are updated. When billing, you must use the most appropriate code as of the effective date of the submission. Unlisted, unspecified and nonspecific codes should be avoided.
  • Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. 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. 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. The member's benefit plan determines coverage. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern.
  • In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. 

See CMS's Medicare Coverage Center

 

  • Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change.
  • Since Clinical Policy Bulletins (CPBs) 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. Under certain circumstances, your physician may request a peer to peer review if they have a question or wish to discuss a medical necessity precertification determination made by our medical director in accordance with Aetna’s Clinical Policy Bulletin.
  • 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 the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. 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. 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.

See Aetna's External Review Program

 

  • 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). 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.
  • 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 or related to any use, nonuse or interpretation of information contained in Aetna Clinical Policy Bulletins (CPBs). No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. 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. Applicable FARS/DFARS apply.

 

LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT®")

 

CPT only copyright 2015 American Medical Association. All Rights Reserved. CPT is a registered trademark of the American Medical Association.

 

You, your employees and agents are authorized to use CPT only as contained in Aetna Clinical Policy Bulletins (CPBs) solely for your own personal use in directly participating in healthcare programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT.

 

Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized herein must be obtained through the American Medical Association, CPT Intellectual Property Services, 515 N. State Street, Chicago, Illinois 60610. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt.

 

Go to the American Medical Association Web site

 

U.S. Government Rights

 

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. 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.

 

Disclaimer of Warranties and Liabilities.

 

CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. No fee schedules, basic unit, relative values or related listings are included in CPT. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or 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.

 

This Agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this Agreement.

 

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The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services.

 

This information is neither an offer of coverage nor medical advice. It is only a partial, general description of plan or program benefits and does not constitute a contract. In case of a conflict between your plan documents and this information, the plan documents will govern.

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