Aetna
Aetna
Policy
Note: Some plans have limitations or exclusions applicable to chiropractic care. Please check benefit plan descriptions for details.
Aetna considers chiropractic services medically necessary when all of the following criteria are met:
The member has a neuromusculoskeletal disorder; and
The medical necessity for treatment is clearly documented; and
Improvement is documented within the initial 2 weeks of chiropractic care.
If no improvement is documented within the initial 2 weeks, additional chiropractic treatment is considered not medically necessary unless the chiropractic treatment is modified.
If no improvement is documented within 30 days despite modification of chiropractic treatment, continued chiropractic treatment is considered not medically necessary.
Once the maximum therapeutic benefit has been achieved, continuing chiropractic care is considered not medically necessary.
Chiropractic manipulation in asymptomatic persons or in persons without an identifiable clinical condition is considered not medically necessary.
Chiropractic care in persons, whose condition is neither regressing nor improving, is considered not medically necessary.
Manipulation is deemed experimental and investigational when it is rendered for non-neuromusculoskeletal conditions such as dysmenorrhea and epilepsy (not an all inclusive list) because its effectiveness for these indications is unproven.
Chiropractic manipulation is not considered medically necessary for treatment of idiopathic scoliosis or for treatment of scoliosis beyond early adolescence, unless the member is exhibiting pain or spasm, or some other medically necessary indications for chiropractic manipulation is present.
Aetna considers the following chiropractic procedures experimental and investigational:
Active Release Technique (see CPB 388 - Complementary and Alternative Medicine)
Applied Spinal Biomechanical Engineering
BioEnergetic Synchronization Technique
Chiropractic Biophysics Technique
Cranial Manipulation
Coccygeal Meningeal Stress Fixation Technique
Directional Non-force Technique
Manipulation for Internal (non-neuromusculoskeletal) Disorders (Applied Kinesiology)
Manipulation Under Anesthesia (see CPB 204 - Spinal Manipulation Under Anesthesia)
Moire Contourographic Analysis
Network Technique
Neural Organizational Technique
Sacro-Occiptal Technique
Spinal Adjusting Devices (ProAdjuster, PulStarFRAS, Activator)
Upledger Technique and Craniosacral Therapy.
Aetna considers the following diagnostic procedures experimental and investigational:
Thermography - see CPB 029 - Thermography
Paraspinal Electromyography (EMG)/Surface Scanning EMG - see CPB 112 - Surface Scanning and Macro Electromyography
Spinoscopy - see CPB 112 - Surface Scanning and Macro Electromyography
Neurocalometer/Nervoscope - see CPB 029 - Thermography.
Aetna Inc.
151 Farmington Avenue
Hartford, CT 06156
USA
Phone: (860) 273-0123
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