Clinical Policy Bulletins
Clinical Policy Bulletins (CPBs) state Aetna’s policy regarding the medical necessity or investigational status of medical technologies and other services to aid in coverage decisions. They are created by a national review team and are based on published medical literature, formal technology assessments and structured evidence reviews, evidence-based consensus statements, expert opinions and evidence-based guidelines from professional and public health entities.
Clinical Practice Guidelines
Clinical Practice Guidelines document best practices and recommendations for care, as determined by respected professional and public health organizations. To help provide our members with consistent, high quality care that uses services and resources effectively, we provide links to a selection of guidelines for conditions and situations important to the health of our members. Some of these are treatment protocols, while others document recommended preventive health measures.
These guidelines are intended to clarify standards and expectations. They should not:
- Take precedence over your responsibility to provide treatment based on the member’s individual needs
- Substitute as orders for treatment of a member
- Guarantee coverage or payment for the type or level of care proposed or provided
Clinical policy bulletins
Clinical practice guidelines
Use these resources to find information about specific treatment types and guidelines.
Disease Management Condition
Adult Preventive Care
Adult Preventive Screenings
American Academy of Pediatrics (AAP): ADHD: Clinical Practice Guideline for the Diagnosis, Evaluation and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents, October 2019
Chronic Obstructive Lung Disease (COPD)
Congestive Heart Failure (CHF)
Coronary Artery Disease
Elderly and Disabled Information
Home and Community Based Services
Long Term Care
Opioids for Chronic Pain
Pediatric Preventive Guidelines