Aetna CPB: Experimental & Investigational Test Coverage
December 20, 2010At times, members unexpectedly have to pay for lab tests they thought were covered services. Although these tests were ordered by their physicians, these procedures are experimental or investigational based upon evidence-based standards. As a result, they are not covered under the terms of the member’s health plan.
Reminder: Aetna plans do not cover laboratory tests that are considered experimental or investigational, even when these studies are ordered by a participating physician.
The chart below lists some of the most commonly ordered experimental or investigational lab tests.
| Lab Test | Aetna Clinical Policy Bulletin (CPB) |
| Homocysteine cardiovascular test (83090) | 0381, 0562 |
| Lipoprotein (A) (83695) | 0381 |
| Immunoassay for tumor antigen, quantitative CA 19-9 (86301) | 0352 |
| Infectious agent detection by nucleic acid (DNA or RNA); (87621) | 0443 |
| PCR test for Lyme disease (87476) | 0215, 0650 |
| VAP cholesterol test (83701) | 0381 |