Aetna Complementary Alternative Medicine Coverage

Medical Necessity General Statement

Covered when ALL of the following are met

Medical necessity general rule: Alternative medicine interventions are considered medically necessary if supported by adequate evidence of safety and effectiveness in the peer‑reviewed published medical literature and are subject to applicable benefit plan limitations and exclusions.

Cross-reference to specific CPBs applies (examples: acupuncture CPB 0135; biofeedback CPB 0132; chelation therapy CPB 0234; chiropractic services CPB 0107; electrical stimulation CPB 0011).

Experimental and Investigational

Interventions considered experimental and investigational

Listed experimental/investigational interventions: Specific complementary and alternative medicine (CAM) interventions enumerated in this bulletin are considered experimental and investigational due to inadequate evidence of effectiveness in the peer‑reviewed published medical literature (document lists many interventions including but not limited to: acoustic therapy for anxiety/depression; active release technique; acupressure; apitherapy/bee sting therapy; bioidentical hormones; colon hydrotherapy/colonic lavage; Glutathione infusion; intravenous micronutrient therapies including Myers' Cocktail; neural therapy; pharmaco‑puncture; Pilates; placentophagy/placenta capsules; Patricia Kane (PK) Protocol; Traumeel; vibro‑acoustic therapy; vibratory pads; wilderness programs; Zeel injection and other listed items).

The document enumerates 175+ individual interventions designated experimental/investigational.

Exclusions — Nutritional Supplements

Policy Limitations and Exclusions

Nutritional supplements exclusion: Aetna standard benefit plans exclude coverage of nutritional supplements. Examples listed include bilberry; black cohosh; bovine cartilage; cat’s claw; Coriolus versicolor mushroom; echinacea; fish oil; Ginkgo biloba; glucosamine; kava; milk thistle; saw palmetto; shark cartilage; St. John’s wort; valerian; and yohimbine.

Check the member's specific benefit plan description for definitive coverage/exclusion details.

Summary evidence (no explicit coverage rules)

Evidence summaries and conclusions for various CAM therapies (no explicit coverage criteria in this segment).

CAM modalities summarized: Multiple CAM therapies are summarized with generally limited, mixed, or preliminary evidence. Examples include: topical calendula and Traumeel S mouthwash (preliminary positive trials for radiotherapy dermatitis and chemotherapy stomatitis respectively); Pilates (superior to minimal intervention for pain but not superior to other exercise for disability); IV micronutrient therapy/Myers' Cocktail (pilot RCTs show within‑group improvements but no between‑group superiority); and bioidentical/compounded hormones (lack rigorous safety/efficacy data and quality concerns).

This section provides evidence summaries rather than prescriptive coverage rules.

Coverage considerations — interventions lacking sufficient evidence

Summary coverage stance based on presented evidence:

General CAM coverage logic

Interventions with at best preliminary/insufficient evidence: Examples: Pilates (pain benefit vs minimal intervention but no superiority to other exercise); bee sting therapy (no benefit in MS RCT); IVMT/Myers' Cocktail (pilot RCT in fibromyalgia with high placebo response and no between‑group superiority); IV vitamin C for herpes zoster (observational data); glutathione infusions (biologic rationale and small/limited studies); salt room therapy, vibro‑acoustic therapy, MNRI, wilderness programs (small pilot/observational evidence); vibratory pads for RLS (possibly ineffective per guideline).
Consider requirement for higher‑quality evidence before authorizing routine coverage.

Wilderness Programs

Evidence-based coverage considerations and clinical positioning summarized from citations:

Wilderness/adventure programs: Longer‑term residential wilderness/adventure programs may be considered for adolescents with substance use disorder only after failure of less intensive treatments; no randomized clinical trials exist and observational data are limited; some programs may be ineffective or potentially harmful.after failure of less intensive treatment

Cited UpToDate review; consider program‑specific evidence and safety concerns.

Vibratory Pads

Therapies with guideline or review statements about effectiveness:

Vibratory pads for RLS: Vibratory pads (vibratory stimulation) are described in an AAN practice guideline summary as possibly ineffective for treating restless legs syndrome symptoms.

May be considered not effective for RLS per guideline statement.

Colon Hydrotherapy

Interventions with insufficient evidence and reported harms:

Colon hydrotherapy: Systematic review found no methodologically rigorous controlled trials supporting colonic cleansing for general health promotion, and multiple case reports/series describe adverse effects; current literature does not support recommending colonic cleansing for general health.

Not supported by literature; potential for adverse events reported.

Gua Sha and TCM

Traditional Chinese Medicine modalities (Gua Sha, acupuncture, cupping, tai chi, qigong):

Gua Sha and related TCM modalities: Systematic reviews and randomized trials report moderate or immediate‑term benefits for acupuncture versus sham for neck and low back pain, and some evidence that cupping and acupressure may reduce pain; Gua Sha, tai chi, and qigong show fair effects in some studies but evidence is heterogeneous and insufficient for definitive conclusions; overall these modalities are relatively safe but require further rigorous studies for firm recommendations.

Evidence varies by modality and condition; benefits often immediate or short‑term and study quality is variable.

Placentophagy / Placenta Capsules

Placentophagy / Placenta Capsules evidence and safety:

Placentophagy clinical stance: Randomized and pilot trials show no robust benefit of ingested encapsulated placenta for postpartum iron status, mood, bonding, or fatigue; encapsulated placenta provides only modest amounts of some micronutrients and may contain hormones; case reports (including a neonatal group B Streptococcus sepsis) prompted CDC advisory to avoid placenta capsule ingestion due to contamination risk. Clinicians should discourage placentophagy and inquire about placenta ingestion when evaluating postpartum maternal or neonatal infection.

Potential harm with minimal documented benefit; counseling recommended.

Acupressure

Acupressure evidence summaries:

Acupressure: Systematic reviews and RCTs suggest acupressure may provide immediate relief of pretreatment anxiety, reduce postoperative nausea/vomiting, and may help chronic nonspecific low back pain and sleep quality in some trials; overall evidence is limited by heterogeneity, variable protocols, and risk of bias. Acupressure may be considered as an adjunct in selected circumstances with appropriate patient counseling about limited evidence.

Protocols and effects vary; supportive but not definitive evidence.

Medical Marijuana

Medical marijuana evidence summary:

Medical marijuana for chronic pain: Systematic review evidence indicates low‑strength support that plant‑based cannabis may alleviate neuropathic pain in some adults, but evidence is insufficient for most other chronic pain conditions; harms reported include increased risk of motor vehicle accidents, psychotic symptoms, and short‑term cognitive impairment; long‑term harms data are limited.

Aetna does not cover medical marijuana as it is not an FDA‑approved prescription medication; check member benefit plan.

Evidence summaries (informational)

Evidence summaries and conclusions per topic (no explicit policy coverage rules in this excerpt):

Acupressure summary: Limited RCT and review data suggest potential small benefits for preoperative anxiety, allergic rhinitis symptoms, and labor pain at specific points; additional rigorous trials are needed.

References cited in bulletin.

Medical marijuana summary: Low‑strength evidence supports neuropathic pain benefit in some adults; insufficient evidence for many other indications and harms should be considered when assessing risk/benefit.

References: systematic reviews summarized in the bulletin.

Chronic rhinosinusitis CAM summary: Many CAM interventions for CRS lack robust clinical evidence; some agents (therapeutic ultrasonography, phonophoresis, additives to saline lavage, Sinupret) show preliminary support but higher‑quality RCTs are required.

Further research needed.

Evidence summaries

Summarized evidence conclusions present in the document sections below:

Exosome therapy evidence summary: Exosomes/EVs show potential as biomarkers and therapeutic delivery systems in preclinical and early translational studies, but optimal source selection, reproducible isolation, and safety/efficacy in humans remain uncertain; further basic and clinical research is needed.

Not established for routine therapeutic use.

Intravenous curcumin (adjunct to paclitaxel): A randomized double‑blind trial in metastatic/advanced breast cancer reported higher objective response rate with weekly IV curcumin 300 mg plus paclitaxel versus paclitaxel+placebo at 4 weeks, with no major safety issues reported; authors call for further trials to confirm findings.

Evidence limited to specific trial contexts; not general coverage endorsement.

Intravenous magnesium with lidocaine for fibromyalgia: Retrospective data suggest IV lidocaine reduces pain in fibromyalgia with a nonsignificant trend favoring addition of magnesium; UpToDate does not list IV magnesium as a treatment, and larger prospective studies are needed.

Evidence insufficient to support routine coverage.

Evidence summaries — CAM modalities

Evidence-based coverage considerations (summary of findings)

Viscosupplementation evidence summary: Meta‑analyses and pooled trials support hyaluronan/hylan viscosupplementation for knee osteoarthritis with measurable benefits for pain and function, especially at 5–13 weeks post‑injection; effect sizes and duration vary by product and outcome, and few randomized head‑to‑head comparisons exist.5-13 weeks noted period

Prior conservative therapy and clear indication documentation recommended.

Motor imagery for stroke rehabilitation: Motor imagery used as an adjunct to conventional rehabilitation has demonstrated improvements in motor performance in RCTs, but protocols are heterogeneous and higher‑quality standardized studies are needed.practice at least twice‑weekly during 3 weeks noted in some studies

Adjunctive use may be considered in rehabilitation settings.

Inhalation aromatherapy in hospitalized pediatrics:

Aetna standard benefit plans exclude coverage of nutritional supplements. Examples listed in the policy include bilberry, black cohosh, bovine cartilage, echinacea, fish oil, ginkgo biloba, glucosamine, kava, milk thistle, saw palmetto, shark cartilage, St. John’s wort, valerian, and yohimbine. Additionally, Aetna does not cover medical marijuana because it is not an FDA‑approved prescription medication; providers and members should check specific benefit plan descriptions for details.

Compounded products, including bioidentical hormones, are not FDA‑approved and may lack required class labeling, warnings and contraindications. FDA testing of compounded product samples identified a 34% failure rate in quality testing, with many failing assay or potency checks, raising concerns about variable purity, potency and overall quality; professional societies (e.g., ACOG, Endocrine Society) advise caution and note insufficient evidence of superior safety or effectiveness for individualized compounded regimens.

The policy summarizes trial and guideline evidence showing lack of benefit for certain modalities: a randomized cross‑over trial of bee sting (apitherapy) in multiple sclerosis found no reduction in disease activity or improvement in disability, fatigue or quality of life. The American Academy of Neurology practice summary also designates bee sting therapy as possibly ineffective for MS relapses. Similarly, vibratory pads (vibratory stimulation) are described in the AAN guideline summary as possibly ineffective for treating restless legs syndrome symptoms.

Systematic review evidence does not support colonic cleansing/colon hydrotherapy for general health promotion: methodologically rigorous controlled trials are lacking, and multiple case reports and series describe adverse events. Consequently, the practice cannot be recommended at this time based on available literature.

Human placentophagy (placenta encapsulation) shows no robust clinical benefit in randomized or pilot trials for postpartum outcomes and provides only modest trace nutrient content after processing. The CDC has warned about infectious risk after a reported case of neonatal group B Streptococcus sepsis linked to contaminated placenta capsules; authors recommend clinicians discourage placentophagy and inquire about placenta ingestion when evaluating postpartum maternal or neonatal infections.

Several interventions are identified as having insufficient evidence to demonstrate clinical value. For example, the Patricia Kane (PK) Protocol (an IV infusion regimen) lacks evidence regarding clinical benefit. Homeopathic and other preparations (e.g., Spascupreel) similarly lack high‑quality data supporting safety or effectiveness; such interventions are considered experimental/investigational in the policy.

Use of colloidal silver products is associated with documented risks — notably argyria — and marketing claims for therapeutic benefit are frequently unsupported by scientific evidence. Case reports and reviews highlight potential toxicity and the need for regulatory oversight of such products.

The homeopathic product Neuralgo‑Rheum injection, promoted for neuropathic pain and soft tissue rheumatism, has a stated lack of evidence regarding safety and effectiveness in the peer‑reviewed literature; the policy identifies this as a rationale for not supporting its use outside of rigorous clinical research.

Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits but they are not offers of coverage and do not constitute a contract. CPBs provide a partial, general description of plan or program benefits; providers should follow specific plan provisions and program disclosures for definitive coverage and prior authorization requirements.

This CPB explicitly lists a large number (175+) of complementary and alternative medicine interventions that Aetna considers experimental and investigational because peer‑reviewed evidence is inadequate to establish effectiveness. The enumerated list includes diverse modalities (for example, acoustic therapy, active release technique, acupressure, apitherapy, bioidentical hormones, colon hydrotherapy, Gua Sha, pharmaco‑puncture, and many others) that would generally be considered not medically necessary in the absence of high‑quality supporting evidence.

Specific CAM interventions such as neural therapy and insulin potentiation therapy are described as lacking reliable evidence of effectiveness. Neural therapy involves injection of local anesthetics into varied sites and research to date is insufficient to support its clinical use; insulin potentiation therapy has no published studies demonstrating safety and effectiveness and is considered unsupported.

Provider Responsibilities, Prior Authorization and Documentation

Prior Authorization

Prior Authorization and Affected Codes

Prior authorization may be required for certain Complementary and Alternative Medicine (CAM) services and specific CPT/HCPCS codes identified as not covered for listed indications. Providers should verify plan-specific prior authorization rules before scheduling or billing services.

Affected codes include CPT/HCPCS listed in the CPT/HCPCS section of this CPB (examples: 0736T, 0771T-0774T, 86353, 90880, 96360, and HCPCS entries for IV micronutrient therapy and IV vitamin C).
Some codes are explicitly listed as not covered for the indications in this CPB; obtain prior authorization where the member’s benefit requires it.

Prior Authorization

Prior Authorization for Traumeel or Homeopathic Agents

Evidence for Traumeel and other homeopathic agents is limited and inconsistent. When these agents are considered, prior authorization may be appropriate to ensure documentation of indication and that less experimental options were tried or documented as unsuitable.

Trials of Traumeel show mixed results (some small trials with transient or limited benefit); reproduceability is lacking.
If Traumeel or other homeopathic agents are to be billed, check benefit coverage and obtain prior authorization when plan requires it, providing rationale and supporting documentation.

Prior Authorization

Prior Authorization Advisable for CAM Therapies

Many CAM therapies (including IV/infusion therapies, homeopathic products, and other interventions with limited or conflicting evidence) are associated with an evidence gap that may prompt prior authorization or denial. Providers should anticipate prior authorization requests and be prepared to justify medical necessity.

IV/infusion CAM therapies (IV micronutrient therapies, IV vitamin C, glutathione infusions, PK Protocol) often lack robust evidence; prior authorization is advisable.
Products or therapies lacking convincing safety/effectiveness data (e.g., Neuralgo-Rheum, some homeopathic injections) may be treated as investigational/experimental and require prior authorization or be denied per plan terms.

Prior Authorization

Prior Authorization Recommended for Viscosupplementation

Viscosupplementation (hyaluronan/hylan) for knee osteoarthritis demonstrates evidence of benefit in multiple trials; however, prior authorization is recommended to document indication, prior therapies tried, and expected timing of benefit.

Document diagnosis of knee osteoarthritis and prior conservative therapy (e.g., NSAIDs, physical therapy, intra-articular corticosteroids) when requesting authorization.
Include expected benefit timing (commonly 5–13 weeks post-injection) and prior trial outcomes to support medical necessity.
Prior authorization references and criteria should be checked against the specific plan’s CPB and utilization management rules.

Note

Prior Authorization Guidance and References

This CPB and accompanying bulletin are intended to assist in administering benefits; they do not replace plan-specific prior authorization requirements. Always follow the member’s benefit documents and check payer systems for current prior authorization policies and affected codes.

Clinical Policy Bulletins summarize evidence and typical prior authorization considerations but are not definitive coverage warranties.
Refer to the payer’s authorization portal or contact the plan for up-to-date prior authorization references and operational guidance.

Documentation Required

Placentophagy Safety Concern and Documentation

Placentophagy (placenta ingestion or placenta capsules) has no documented clinical benefit and carries documented infectious risk (including reported neonatal GBS sepsis). Counsel patients against ingestion and document that counseling; inquire about placenta ingestion when evaluating postpartum infections.

Document counseling discouraging placentophagy and record any member history of placenta ingestion.
If a postpartum maternal or neonatal infection occurs, document inquiry about placenta ingestion and potential linkage as part of the clinical assessment.

Denial Risk

PK Protocol — Evidence Gap and Authorization Risk

The Patricia Kane (PK) Protocol and some other IV infusion regimens lack sufficient evidence of clinical value. This evidence gap may lead to authorization denial; when submitting requests, provide robust rationale, prior treatment history, and supporting literature if available.

Document indication, prior therapies tried and failed, and the clinical rationale for choosing the PK Protocol or similar IV regimens.
Be aware that lack of controlled evidence may result in denial as experimental/investigational.

Denial Risk

Lack of Coverage Mention in Major Reviews (Injection/IV Therapies)

UpToDate reviews do not list injection of vitamin B, trace elements, or intravenous magnesium as standard management options for chronic pain or fibromyalgia; absence from major clinical summaries may affect authorization decisions.

When requesting authorization for injections of vitamin B/trace elements, IV magnesium, or similar therapies, include strong clinical justification and prior therapy documentation.
Recognize that reviewers may view these therapies as unsupported by mainstream clinical guidance and may deny coverage.

Denial Risk

Products/Therapies Potentially Classified as Experimental/Investigational

Some products and therapies lack sufficient safety or effectiveness data (e.g., Neuralgo-Rheum, certain homeopathic injections). Such items may be considered experimental/investigational and either require prior authorization with robust justification or may be denied per plan terms.

Confirm product composition and supporting peer-reviewed evidence when preparing authorization requests.
If no adequate evidence exists, expect requests to be reviewed under investigational/exclusion criteria.

Documentation Required

Documentation and Cross-Reference Requirements

Documentation requirements vary by intervention. For IV/infusion CAM therapies, medical records should include the specific indication, prior conservative therapies tried, the rationale for IV administration (why oral/topical routes are insufficient), proposed regimen/dosing, and anticipated benefit. For medical marijuana and other controlled substances, document indication, trial evidence limitations, and risk/benefit discussion.

IV/infusion documentation: indication, prior therapies and dates, clinical rationale for IV route, dosing/regimen, expected timeline and measurable outcomes.
Medical marijuana: document indication, limited evidence discussion, alternatives tried, and detailed risk/benefit counseling per plan requirements.
If no documentation requirements are specified for a particular therapy in the CPB, follow standard medical necessity documentation and the specific plan’s utilization review instructions.

Step Therapy

Conservative Therapy Trial and Stepwise Approach for Exercise-Based Therapies

Conservative, standard therapies should generally be tried and documented before pursuing CAM interventions. For exercise-based therapies (e.g., Pilates) and other nonpharmacologic approaches, use a stepwise approach and document prior conservative treatments and responses.

Document trials of standard conservative care (e.g., physical therapy, NSAIDs, activity modification) and outcomes prior to requesting CAM therapies.
For exercise-based interventions, document prior rehabilitation efforts and rationale for selecting a specific modality (Pilates versus other exercise).

Documentation Required

Evidence and Documentation Considerations for Viscosupplementation

Evidence summaries for viscosupplementation indicate efficacy versus placebo and comparable effectiveness to NSAIDs and sometimes more prolonged benefit than intra-articular corticosteroids for certain products; prior authorization should capture prior NSAID/IA corticosteroid use and clinical goals.

Include documentation of prior NSAID therapy, intra-articular corticosteroid trials (and timing), and patient symptoms/functional limitations.
State the expected timing of benefit (commonly 5–13 weeks) and which product is proposed, as efficacy varies by product and time-point.

Note

Coverage Reliance, Provider Responsibility, and Limits of CPB Guidance

Some sections of this CPB (e.g., reference lists) do not themselves establish authorization criteria. Participating providers are responsible for submitting complete clinical documentation; CPBs are summaries to assist benefit administration and do not guarantee coverage.

When in doubt, verify specific plan coverage, prior authorization rules, and any exclusions (e.g., nutritional supplements) in the member’s benefit documents.
Maintain complete records to support any authorization requests or appeals, including references to peer-reviewed evidence when used to support medical necessity.

Definitions

Alternative medicine — definition

DefinitionTreatments and practices not widely accepted in the traditional medical community; includes holistic, unconventional, and complementary approaches across multiple categories (e.g., manual healing, mind–body, herbal medicine)

CategoriesAlternative systems, bioelectromagnetic therapies, diet/nutrition, herbal medicine, manual healing methods, mind–body interventions, pharmacologic/biologic treatments

Evidence stanceEfficacy of many alternative medicine regimens is generally unproven; some may be ineffective or harmful

Active Release Technique (ART) — definition

DefinitionA patented soft-tissue system using hands-on evaluation and precisely directed tension with specific patient movements to treat muscles, tendons, ligaments, fascia and nerves

Key featuresCombination of examination and treatment; provider assesses texture, tightness and movement; protocols include over 500 specific moves

Evidence noteLimited published evidence; further study required (e.g., Drover et al. 2004 found no benefit for quadriceps inhibition in one trial)

Bioidentical hormones — definition (salivary testing context)

DefinitionHormone preparations manufactured to have the same molecular structure as endogenous hormones, often compounded and individualized based on salivary hormone testing

Practice detailOften custom-made by compounding pharmacies according to salivary test results and physician specifications

Professional guidanceACOG states no scientific evidence supports increased safety or effectiveness for individualized compounded regimens; salivary testing is not meaningful due to variability

Active Release Technique (ART) — definition

DefinitionA patented soft-tissue system using hands-on evaluation and precisely directed tension with specific patient movements to treat muscles, tendons, ligaments, fascia and nerves

Key featuresCombination of examination and treatment; provider assesses texture, tightness and movement; protocols include over 500 specific moves

Evidence noteLimited published evidence; further study required (e.g., Drover et al. 2004 found no benefit in a specific athletic knee study)

Bioidentical hormones — definition (duplicate)

DefinitionHormone preparations manufactured to have the same molecular structure as endogenous hormones, often compounded and individualized based on salivary testing

Compounding riskCompounded bioidentical products are not FDA-approved as individualized regimens and may lack standardized warnings/contraindications

Quality concernTesting has shown variable purity/potency in compounded products, supporting professional caution

Neural therapy — definition

DefinitionAn injection-based CAM practice in which local anesthetics (e.g., lidocaine, procaine) are injected into varied body sites (scars, acupuncture points, glands, trigger points) to eliminate 'interference fields' and restore energy flow

Treatment courseMay involve one or more injections spread over several weeks; differs from conventional nerve blocks

Evidence noteInsufficient evidence on effectiveness for pain management or other health problems; mainly studied in Germany

Glutathione (GSH) — definition

DefinitionReduced glutathione (GSH) is the principal intracellular antioxidant involved in cellular redox balance; exogenous GSH has been studied as an infusion or via precursors to restore intracellular levels

MechanismGSH:GSSG ratio represents cellular antioxidative capacity and influences cell signaling (e.g., NF-kB modulation)

Applications under studyInvestigated as adjuvant in conditions linked to oxidative stress (e.g., intoxication, diabetes, sepsis, contrast nephropathy, cancer), but clinical evidence is limited

Pilates-based exercise — definition

DefinitionA form of exercise emphasizing core strength, flexibility and mindful movement; used in programs targeting persistent non-specific low back pain

Evidence summarySystematic reviews show Pilates superior to minimal intervention for pain but not superior to other exercise for pain or disability; study quality and heterogeneity limit conclusions

Coding/practice noteOften delivered in supervised classes or physical-therapy settings; compare with standard exercise/rehab before specialized programs

Vibratory pads — definition

DefinitionExternal devices that provide vibratory stimulation intended to modulate symptoms (e.g., for restless legs syndrome)

Guideline statementAAN practice guideline summary states vibratory pads are possibly ineffective for treating restless legs syndrome symptoms

Clinical implicationMay be considered ineffective for RLS and unsupported as an evidence-based therapy

Colon hydrotherapy — definition

DefinitionProcedures to cleanse the colon (colonic cleansing/colon hydrotherapy) purported to promote health, often using irrigation or lavage techniques

Evidence summarySystematic review found no methodologically rigorous controlled trials supporting colonic cleansing for general health; multiple case reports describe adverse effects

Coding noteColonic lavage with 35+ liters is specifically coded (CPT 0736T) and identified in CPT list

Placentophagy / placenta encapsulation — definition

DefinitionIngestion of processed placenta (raw, cooked, dehydrated, or encapsulated) claimed to provide postpartum benefits

Evidence and safetyNo scientific evidence of clinical benefit after encapsulation; CDC advised against intake after a case of neonatal group B Streptococcus sepsis linked to contaminated placenta capsules

Clinical recommendationPhysicians should inform patients about reported risks and absence of documented benefits; discourage ingestion

Acupressure — definition

DefinitionApplication of pressure with fingers or small beads at acupuncture points (similar to acupuncture but without needles)

ExamplesEar acupressure using stainless steel pellets in adhesive discs; point-specific pressure such as SP6 or LI4 for labor pain

Evidence noteSome trials and reviews suggest small benefits for anxiety, postoperative nausea, and select pain outcomes; overall evidence is heterogeneous

Plant-based cannabis preparations (medical marijuana) — definition

DefinitionPreparations derived from cannabis plants studied for indications such as chronic pain and PTSD; formulations and evidence vary by indication

EvidenceLow-strength evidence for neuropathic pain relief; insufficient evidence for many other pain types; harms include increased risk of motor vehicle accidents and psychotic symptoms

Coverage noteAetna does not cover medical marijuana as it is not an FDA‑approved prescription medication under standard benefit plans

Exosomes — definition

DefinitionSmall extracellular vesicles (exosomes/EVs; ~30–120 nm) secreted by cells that contain lipids, proteins and nucleic acids and mediate intercellular communication

Research potentialInvestigated as biomarkers and as natural nano-delivery vehicles with immunomodulatory and regenerative properties; therapeutic use remains investigational

Technical challengesIsolation reproducibility, source selection, and safety concerns limit clinical application until further research is done

Exosomes / EVs — duplicate definition

DefinitionLipid membrane extracellular vesicles released by cells that carry proteins, lipids and nucleic acids and mediate cell–cell communication

Therapeutic noteHigh translational interest for regenerative medicine and drug delivery but unclear which exosome sources are optimal to avoid side effects

Evidence statusPreclinical and early translational studies predominate; clinical safety and efficacy data are lacking

Pharmaco‑puncture — definition

DefinitionAn acupuncture technique involving injection of pharmacologic agents or herbal extracts into acupuncture points (pharmaco‑acupuncture)

Geographic useUsed primarily in Korea and China for various symptoms including cancer-related symptom management

Evidence noteSystematic reviews identify heterogeneous, generally low-quality RCTs; some trials report symptom relief but methodological flaws limit firm conclusions

Viscosupplementation — definition (hyaluronan/hylan products)

DefinitionIntra‑articular injection of hyaluronan/hylan products for treatment of knee osteoarthritis to improve pain and function

Product heterogeneityMultiple hyaluronan/hylan products (e.g., Hyalgan, Synvisc, Orthovisc, Durolane, Zeel compositum) exist with variable efficacy by product and time-point

Evidence timeframePooled analyses show notable pain/function improvement particularly at 5–13 weeks post-injection (pain improvement ~28%–54%)

Viscosupplementation — duplicate definition

DefinitionIntra-articular injection of hyaluronan/hylan products for knee osteoarthritis; effects vary by product, outcome and time-point

Effect size noteMeta-analyses of multiple trials demonstrate variable comparative efficacy and timing of benefit; few head-to-head randomized comparisons

Clinical implicationPrior authorization and documentation of diagnosis/prior therapies may be appropriate given heterogeneous evidence

Virtual Reality (VR) distraction — definition

DefinitionUse of immersive, semi-immersive, or non-immersive virtual reality during procedures to reduce acute pain, distress and anxiety (procedural distraction)

Evidence summarySystematic reviews in children show low-to-very-low certainty evidence with heterogeneous results; some studies report reduced procedural pain or distress but risk of bias and small sample sizes limit confidence

CodingRelated CPT/HCPCS codes include 0771T–0774T for VR procedural dissociation services (initial and additional 15-minute increments)

Motor imagery — definition

DefinitionA rehabilitation technique involving mental rehearsal of movements used as a complement to conventional rehabilitation to improve motor function after stroke

Protocol noteSome studies report benefit when practiced at least twice-weekly over several weeks, but protocols are heterogeneous (session duration and timing vary)

Evidence summarySystematic review included 10 RCTs showing motor performance improvement, but greater standardization and higher-quality trials are needed

Complementary and Alternative Medicine (CAM) — definition

DefinitionComplementary and Alternative Medicine (CAM): a broad set of modalities not part of conventional standard medical care, including but not limited to acupuncture, aromatherapy, herbal therapies, homeopathy, massage, music therapy, VR, and other nonconventional treatments

ScopeCAM encompasses alternative systems, bioelectromagnetic therapies, diet/nutrition, herbal medicine, manual healing, mind–body interventions, and pharmacologic/biologic treatments

Policy stanceEfficacy of many CAM regimens is generally unproven; some may be ineffective or harmful—policy lists many interventions as experimental/investigational

0736T	Colonic lavage, 35 or more liters of water, gravity-fed, with induced defecation, including insertion of rectal catheter.
0771T	Virtual reality (VR) procedural dissociation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the VR procedural dissociation supports; initial 15 minutes of intraservice time, patient age 5 years or older (requires independent, trained observer).
0772T	Virtual reality (VR) procedural dissociation; each additional 15 minutes intraservice time (List separately in addition to code for primary service).
0773T	Virtual reality (VR) procedural dissociation services provided by a physician or other qualified health care professional other than the physician or other qualified health care professional performing the diagnostic or therapeutic service that the VR procedural dissociation supports; initial 15 minutes of intraservice time, patient age 5 years or older.
0774T	Virtual reality (VR) procedural dissociation; each additional 15 minutes intraservice time (List separately in addition to code for primary service).
86353	Lymphocyte transformation, mitogen (phytomitogen) or antigen induced blastogenesis [total antioxidant function testing, e.g., Spectrox].
90880	Hypnotherapy.
96360	Intravenous infusion, hydration; initial 31 minutes to 1 hour [not covered for intravenous micronutrient therapy (Myers' Cocktail) or Vitamin C infusions].
96900	Actinotherapy (ultraviolet light) [Biophotonic Therapy].
20974	Electrical stimulation to aid bone healing; noninvasive (nonoperative).

F32.0 - F32.9	Major depressive disorder, single episode.
F33.0 - F33.9	Major depressive disorder, recurrent.
F41.0 - F41.9	Other anxiety disorders.
F41.0	Panic disorder [not covered for weighted blanket].
F51.0 - F51.3	Insomnia not due to a substance or known physiological condition.
G47.0 - G47.09	Insomnia.
G89.4	Chronic pain syndrome.
M79.7	Fibromyalgia.
D83.0 - D83.9	Common variable immunodeficiency.
G62.89	Other specified polyneuropathies [chemotherapy-induced neuropathy].

OpenPayer

Complementary and Alternative Medicine

Coverage Criteria and Evidence Summary

Billing Codes and Coding Guidance

Provider Responsibilities, Prior Authorization and Documentation

Background and Scope

Definitions

Policy Dates and Revision History