Aetna Experimental and Investigational Labs Coverage Reminder

January 2020 ~

Aetna has released a notice, informing patients and providers, that the insurer considers certain laboratory tests to be experimental and investigational. According to the insurer, these non-covered laboratory tests are not covered by most of the insurer’s plans. This may result in patients may be responsible for the full cost of these laboratory tests.

The most common tests that may not be covered are as follows:

  • Lyme Disease (CPB #0215)
  • Vitamin D Assay (CPB #0945)
  • Lipoprotein Cholesterol Test (CPB #0381)
  • Homocysteine Test (CPB #0381)

Informing Patients:

Aetna reminds providers that it is important for patients understand that they are financially responsible for these tests, as they are non-covered services. Physicians should remind patients at the time (of the test order) that they are responsible for the full cost of the laboratory tests.

The insurer provides an online reference tool listing laboratory tests that are considered experimental and investigational or that may be conditionally covered. Access this tool on Aetna’s provider website. You can also view corresponding Clinical Policy Bulletins (CPBs), which are posted alongside the CPT® code descriptions.

CPT® is a registered trademark of the American Medical Association.



Source(s): OfficeLink Updates Newsletters – Important Reminders;