![]() 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. 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. INETWORK AUTO GROUP CHARLOTTE NC PLUSĪpplies 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.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. All services deemed "never effective" are excluded from coverage.Not all plans are offered in all service areas. ![]() INETWORK AUTO GROUP CHARLOTTE NC PROFESSIONALĪetna 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 for more information. The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT ®), copyright 2020 by the American Medical Association (AMA).Ĭlick on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search.". ![]() 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.ĬPT 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 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. INETWORK AUTO GROUP CHARLOTTE NC PROFESSIONALĪny 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.
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