Links to various Aetna Better Health and non-Aetna Better Health sites are provided for your convenience. The provider network is subject to change. If you do not intend to leave our site, close this message. Since Dental Clinical Policy Bulletins (DCPBs) can be highly technical and are designed to be used by our professional staff in making clinical determinations in connection with coverage decisions, members should review these Bulletins with their providers so they may fully understand our policies. Under certain plans, if more than one service can be used to treat a covered person's dental condition, Aetna may decide to authorize coverage only for a less costly covered service provided that certain terms are met. If you have any questions about authorization requirements or need help with the search tool, contact Aetna Better Health Provider Relations at 1-855-364-0974. In case of a conflict between your plan documents and this information, the plan documents will govern. Please correct the following errors and try again: Fill out the form below to find providers and healthcare facilities near you. . . CPT is a registered trademark of the American Medical Association. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. YES - Prior authorization request is required for this service. License to sue CPT for any use not authorized herein must be obtained through the American Medical Association, CPT Intellectual Property Services, 515 N. State Street, Chicago, Illinois 60610. The Dental Clinical Policy Bulletins (DCPBs) describe Aetna's current determinations of whether certain services or supplies are medically necessary, based upon a review of available clinical information. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. Aetna 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. Members must reside in a county where Aetna Medicare offers a DSNP. Medicaid your for low-income and working humans or families, their . All provider information contained on this website is subject to change. No fee schedules, basic unit, relative values or related listings are included in CPT. Please log in to your secure account to get what you need. Important information for Provider Search users who live in California , Colorado , Connecticut , Delaware , Florida . ALL inpatient confinements require PA and usually ALL services provided by non-participating providers require PA. PA requirement results are valid as of todays date only. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. We're sorry but Provider Locator doesn't work properly without JavaScript enabled. In case of a conflict between your plan documents and this information, the plan documents will govern. ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. The five character codes included in the Aetna Clinical Policy Bulletins (CPBs) are obtained from Current Procedural Terminology (CPT), copyright 2015 by the American Medical Association (AMA). Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Just scroll down to "Find local care. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. If English is not your preferred language and you need help communicating in your preferred language, you may call 888-703-6999 to ask what language services are available to you. Explore our savings, quality care and wellness solutions to craft the perfect plan for your business. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Depending on the members MSP eligibility, they may have a cost-share responsibility. Adult day services, assisted living, home-delivered meals, home health agencies and home medical equipment providers. Find a Dentist. CMS requires providers to take the Model of Care training course (PDF). Provider manuals | Manuals | Aetna Better Health of Pennsylvania It is only a partial, general description of plan or program benefits and does not constitute a contract. You can email your search results or print them. 2020 Guardian. This information is neither an offer of coverage nor medical advice. Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna). Aetna Smart Compare is a designation we give to doctors in our network who have proven time and again that they provide high-quality, effective care. Treating providers are solely responsible for medical advice and treatment of members. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. 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