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Submission: On December 22 via api from US — Scanned from DE
Effective URL: https://www.aetna.com/individuals-families.html?cid=eml-m-1039122&sub=364702755
Submission: On December 22 via api from US — Scanned from DE
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Skip to main content Contact us Español logo * Contact us * Español Search Explore Aetna sites * EXPLORE AETNA SITES * Individuals & Families * Affordable Care Act * Medicare * Medicaid * Providers * Employers * Agents & Brokers * Partners * Careers * About Us Explore Aetna sites * Individuals & Families * Affordable Care Act * Medicare * Medicaid * Providers * Employers * Agents & Brokers * Partners * Careers * About Us * Explore plans * Medicare * Browse Aetna Medicare plans * Find a doctor * Check our drug list * Understand Medicare * Find a plan to meet your needs * Enroll in Medicare * Health coverage * ACA individual and family health plans * Health plans through an employer * Options without employer coverage * Student plans * International plans * Dental, vision and supplemental * Dental plans * Find a dentist * Vision plans * Find an eye doctor * Supplemental plans * Pharmacy * Get pharmacy plan information * Find a pharmacy * Medicaid * Medicaid plans * Find a doctor secondary menu close * Member support * Account management * Log in to your member website * Find a form * Get your ID card opens in secure site * Check a claim opens in secure site * View coverage opens in secure site * The health guide * All health resources * Living healthy * Understanding health care * Managing health * Additional resources * Mental health * Women's health * Health insurance rights and resources * Contact us * Frequently asked questions * Prior authorization guidelines secondary menu close * Find a doctor * Find a medication Member login Member login Back Menu Mobile menu for the website. Navigation Menu Menu Close Search * Explore plans * Member support * Find a doctor * Find a medication * Explore Aetna sites * Contact us * Español Member login EXPLORE PLANS * Medicare * Health coverage * Dental, vision and supplemental * Pharmacy * Medicaid * MEMBER SUPPORT * Account management * The health guide * Additional resources * * EXPLORE AETNA SITES * Individuals & Families * Affordable Care Act * Medicare * Medicaid * Providers * Employers * Agents & Brokers * Partners * Careers * About Us MEDICARE * Browse Aetna Medicare plans * Find a doctor * Check our drug list * Understand Medicare * Find a plan to meet your needs * Enroll in Medicare HEALTH COVERAGE * ACA individual and family health plans * Health plans through an employer * Options without employer coverage * Student plans * International plans DENTAL, VISION AND SUPPLEMENTAL * Dental plans * Find a dentist * Vision plans * Find an eye doctor * Supplemental plans PHARMACY * Get pharmacy plan information * Find a pharmacy MEDICAID * Medicaid plans * Find a doctor ACCOUNT MANAGEMENT * Log in to your member website * Find a form * Get your ID card opens in secure site * Check a claim opens in secure site * View coverage opens in secure site THE HEALTH GUIDE * All health resources * Living healthy * Understanding health care * Managing health ADDITIONAL RESOURCES * Mental health * Women's health * Health insurance rights and resources * Contact us * Frequently asked questions * Prior authorization guidelines HEALTH PLANS FOR THE WHOLE YOU Feel your best with individual & family health insurance benefits that focus on you. Explore plans Already a member? Log in WE’RE HERE FOR YOU It’s important to take care of your mental health just like you do your physical health. We’re here to help you achieve both. Mental health support EXPLORE YOUR PLAN OPTIONS PLANS THROUGH WORK If your employer offers Aetna® as a choice for your health plan, start here to see your options. INDIVIDUAL & FAMILY PLANS See the value of Aetna CVS Health™ Affordable Care Act (ACA) individual & family plans. MEDICARE PLANS Learn about medical benefits, drug coverage and extra benefits that go beyond Original Medicare. MEDICAID PLANS Get the basics of this federally and state-funded health insurance program and see if you qualify. DENTAL PLANS Protect your smile with our individual and family dental insurance plans or discount card. Find a doctor Find medication Find a doctor FIND A DOCTOR, DENTIST OR PHARMACY FIND A DOCTOR, DENTIST OR PHARMACY Already a member? Log in to your online account to find providers who accept your plan. Find a doctor Find a pharmacy Guests Pick the plan type you’re interested in to find providers who accept it. CHOOSE PLAN TYPE Select Plan through employer Medicare plan Medicaid plan Individual & family ACA plan Individual dental plan Begin search Looking for pharmacies? Use our pharmacy search tool Find medication SEARCH FOR COVERED DRUGS SEARCH FOR COVERED DRUGS It’s easy. You’ll just need the name of your pharmacy plan to complete your search. Not sure of the plan name? See your Summary of Benefits and Coverage (Aetna members) or check with your HR department. LOADING, PLEASE WAIT Choose plan year Select 202120222023 CHOOSE a PLAN Select FEATURED TOPICS HMO, POS, PPO, EPO AND HDHP WITH HSA: WHAT’S THE DIFFERENCE? 7 COMMON SUICIDE MYTHS — DEBUNKED HSA VS. FSA: WHAT'S THE DIFFERENCE? WHY AETNA? EASY ACCESS More ways to get care with a network of over 1 million national providers, 24/7 virtual care and walk-in care options nationwide. PERSONALIZED GUIDANCE Help making healthy easier with proactive guidance, a 24-hour nurse line for questions after-hours and a team of medical experts. WHOLE HEALTH COVERAGE Coverage for the whole you with preventive screenings and mental health benefits in every medical plan, plus condition-specific support. COVID-19 RESOURCES AND SUPPORT COVID-19 RESOURCES AND SUPPORT Find the latest information on testing, vaccines and treatments. Get my tests COVID-19 resource center AETNA BUSINESS PARTNERS Find resources to help your clients, employees and patients make the most of their benefits. AGENTS & BROKERS EMPLOYERS PROVIDERS NEED HELP? FIND ANSWERS FAQs and other helpful resources. Visit our help page GET IN TOUCH Easy ways to reach us to get the help you need. Contact us PROTECT YOURSELF Your rights against surprise medical bills. Understand the new act LEGAL ENTITIES In Idaho, health benefits and health insurance plans are offered and/or underwritten by Aetna Health of Utah Inc. and Aetna Life Insurance Company. For all other states, health benefits and health insurance plans are offered and/or underwritten by Aetna Health Inc., Aetna Health of California Inc., Aetna Health Insurance Company of New York, Aetna Health Insurance Company, Aetna HealthAssurance Pennsylvania Inc. and/or Aetna Life Insurance Company (Aetna). In Florida, by Aetna Health Inc. and/or Aetna Life Insurance Company. In Utah and Wyoming, by Aetna Health of Utah Inc. and Aetna Life Insurance Company. In Maryland, by Aetna Health Inc., 151 Farmington Avenue, Hartford, CT 06156. DMO dental benefits and dental insurance plans are underwritten by Aetna Dental Inc., Aetna Dental of California Inc., Aetna Health Inc. and/or Aetna Life Insurance Company. Dental PPO and dental indemnity insurance plans are underwritten and/or administered by Aetna Life Insurance Company (Aetna). Each insurer has sole financial responsibility for its own products. Keep your medical information private by requesting a confidential communication. Just call the number on the back of your card. For more information, visit our Health care privacy FAQs. See all legal notices Also of interest: * * * * * * AETNA APPS * CAREERS * FAQs * GLOSSARY * ACCESSIBILITY SERVICES * PLAN DISCLOSURES * PROGRAM PROVISIONS * GRIEVANCE FORM * NEWS AND ANALYSIS * HEALTH CARE REFORM * INVESTOR INFO * SITE MAP * TERMS OF USE * LEGAL NOTICES * PRIVACY CENTER * NONDISCRIMINATION NOTICE * VULNERABILITY DISCLOSURE PROGRAM ©2022 Aetna Inc. For language services, please call the number on your member ID card and request an operator. For other language services: Español-Spanish | 中文 | Tiếng Việt | 한국어 | Tagalog | Pусский | العربية | Kreyòl | Français | Polski | Português | Italiano | Deutsch | 日本語 | فارسی | Other languages ... YOU ARE NOW BEING DIRECTED TO THE AMA SITE Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy or privacy practices of linked sites, or for products or services described on these sites. Continue YOU ARE NOW BEING DIRECTED TO THE GIVE AN HOUR SITE Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy or privacy practices of linked sites, or for products or services described on these sites. Continue YOU ARE NOW BEING DIRECTED TO THE CVS PHARMACY® SITE Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy or privacy practices of linked sites, or for products or services described on these sites. Continue YOU ARE NOW BEING DIRECTED TO THE CDC SITE Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy or privacy practices of linked sites, or for products or services described on these sites. Continue AETNA® IS PROUD TO BE PART OF THE CVS HEALTH FAMILY. You are now being directed to the CVS Health site. Continue YOU ARE NOW BEING DIRECTED TO THE APPLE.COM COVID-19 SCREENING TOOL Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites. Continue YOU ARE NOW BEING DIRECTED TO THE US DEPARTMENT OF HEALTH AND HUMAN SERVICES SITE Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites. Continue YOU ARE NOW BEING DIRECTED TO THE CVS HEALTH COVID-19 TESTING SITE Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites. Continue YOU ARE NOW BEING DIRECTED TO THE FIGHT IS IN US SITE Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites. Continue YOU ARE NOW LEAVING THE AETNA® WEBSITE Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites. Continue LOGIN Please log in to your secure account to get what you need. Continue YOU ARE NOW LEAVING THE AETNA MEDICARE WEBSITE. The information you will be accessing is provided by another organization or vendor. If you do not intend to leave our site, close this message. Continue GET A LINK TO DOWNLOAD THE APP Just enter your mobile number and we’ll text you a link to download the Aetna Health℠ app from the App Store or on Google Play. Message and data rates may apply* Error or missing data. Please check your entries for an error message. MOBILE NUMBER Please be sure to add a 1 before your mobile number, ex: 19876543210 THIS SEARCH USES THE FIVE-TIER VERSION OF THIS PLAN Each main plan type has more than one subtype. Some subtypes have five tiers of coverage. Others have four tiers, three tiers or two tiers. This search will use the five-tier subtype. It will show you whether a drug is covered or not covered, but the tier information may not be the same as it is for your specific plan. Do you want to continue? back Continue APPLIED BEHAVIOR ANALYSIS MEDICAL NECESSITY GUIDE By clicking on “I Accept”, I acknowledge and accept that: The Applied Behavior Analysis (ABA) Medical Necessity Guide helps determine appropriate (medically necessary) levels and types of care for patients in need of evaluation and treatment for behavioral health conditions. The ABA Medical Necessity Guide does not constitute medical advice. Treating providers are solely responsible for medical advice and treatment of members. Members should discuss any matters related to their coverage or condition with their treating provider. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. 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. I Accept AETNA® IS PROUD TO BE PART OF THE CVS® FAMILY. You are now being directed to CVS Caremark® site. Continue ASAM TERMS AND CONDITIONS By clicking on “I accept”, I acknowledge and accept that: Licensee's use and interpretation of the American Society of Addiction Medicine’s ASAM Criteria for Addictive, Substance-Related, and Co-Occurring Conditions does not imply that the American Society of Addiction Medicine has either participated in or concurs with the disposition of a claim for benefits. This excerpt is provided for use in connection with the review of a claim for benefits and may not be reproduced or used for any other purpose. Copyright 2015 by the American Society of Addiction Medicine. Reprinted with permission. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. I accept PRECERTIFICATION LISTS By clicking on “I accept”, I acknowledge and accept that: 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. 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. * Applies 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. Not all plans are offered in all service areas. * All services deemed "never effective" are excluded from coverage. 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. Visit the secure website, available through www.aetna.com, for more information. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search." * 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). CPT 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 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. 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. Any 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. Applicable FARS/DFARS apply. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT®") * CPT only Copyright 2020 American Medical Association. All Rights Reserved. CPT is a registered trademark of the American Medical Association. You, your employees and agents are authorized to use CPT only as contained in Aetna Precertification Code Search Tool solely for your own personal use in directly participating in health care programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT. 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. 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. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. U.S. Government Rights * This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements. Disclaimer of Warranties and Liabilities. * CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. No fee schedules, basic unit, relative values or related listings are included in CPT. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this product. * This Agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this Agreement. * Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". * The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. * This information is neither an offer of coverage nor medical advice. It is only a partial, general description of plan or program benefits and does not constitute a contract. In case of a conflict between your plan documents and this information, the plan documents will govern. I accept DENTAL CLINICAL POLICY BULLETINS By clicking on “I accept”, I acknowledge and accept that: * Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. Treating providers are solely responsible for dental advice and treatment of members. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. * While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. 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. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. 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. Aetna's 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). Your benefits plan determines coverage. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. * Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. * 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. I accept MEDICAL CLINICAL POLICY BULLETINS By clicking on “I accept”, I acknowledge and accept that: Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". * Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. Treating providers are solely responsible for medical advice and treatment of members. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. * While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. Aetna has reached these conclusions based upon a review of currently available clinical information (including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the technology, evidence-based guidelines of public health and health research agencies, evidence-based guidelines and positions of leading national health professional organizations, views of physicians practicing in relevant clinical areas, and other relevant factors). * Aetna makes no representations and accepts no liability with respect to the content of any external information cited or relied upon in the Clinical Policy Bulletins (CPBs). The discussion, analysis, conclusions and positions reflected in the Clinical Policy Bulletins (CPBs), including any reference to a specific provider, product, process or service by name, trademark, manufacturer, constitute Aetna's opinion and are made without any intent to defame. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. * CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. New and revised codes are added to the CPBs as they are updated. When billing, you must use the most appropriate code as of the effective date of the submission. Unlisted, unspecified and nonspecific codes should be avoided. * Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. 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. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. * In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. See CMS's Medicare Coverage Center * Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. * Since Clinical Policy Bulletins (CPBs) 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. * While Clinical Policy Bulletins (CPBs) define Aetna's clinical policy, 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, Aetna provides its members with the right to appeal the decision. In addition, a member may have an opportunity for an independent external review of coverage denials based on medical necessity or regarding the experimental and investigational status when the service or supply in question for which the member is financially responsible is $500 or greater. However, applicable state mandates will take precedence with respect to fully insured plans and self-funded non-ERISA (e.g., government, school boards, church) plans. See Aetna's External Review Program * 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). CPT 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 responsibility for the content of Aetna Clinical Policy Bulletins (CPBs) is with Aetna and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Aetna Clinical Policy Bulletins (CPBs). No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Any use of CPT outside of Aetna Clinical Policy Bulletins (CPBs) should refer to the most current Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. Applicable FARS/DFARS apply. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT®") CPT only copyright 2015 American Medical Association. All Rights Reserved. CPT is a registered trademark of the American Medical Association. You, your employees and agents are authorized to use CPT only as contained in Aetna Clinical Policy Bulletins (CPBs) solely for your own personal use in directly participating in healthcare programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT. 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. License to use 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. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Go to the American Medical Association Web site U.S. Government Rights This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. 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