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 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. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. Just call Member Services at 1-866-329-4701 (TTY: 711) to learn more about these services. 2020 Guardian. Find a Doctor, Dentist or Hospital | Aetna This list is updated nightly. While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. 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. By submitting your information you are agreeing to receive communications from Aetna Dental Offers. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. Avsis provides vision and dental claim and administrative services by agreement with Aetna Inc. Just scroll down to "Find local care. Others have four tiers, three tiers or two tiers. Plan from an employer Aetna Medicare plan, Individual health plan Aetna Medicaid plan Endodontists: help heal infections of the soft tissue inside the tooth and are typically the dental specialist youd see if you need a root canal treatment. If you do not intend to leave our site, close this message. 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. When billing, you must use the most appropriate code as of the effective date of the submission. The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. Primary Care Providers, specialists, mental health providers, Qualified Family Planning Providers (QFFPs), dentists and vision care providers. Family planning, Emergent and Urgent Care services do not require PA.
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