Selective Peripheral Denervation (Bertrand Procedure)
Defines Aetna's medical necessity and investigational criteria for selective peripheral denervation (Bertrand procedure) for treatment of spasmodic torticollis (cervical dystonia), lists related and non-covered procedures, and provides applicable CPT/HCPCS/ICD-10 codes and background evidence.
No material clinical/coverage changes
Coverage Summary
Scope: Defines Aetna's medical necessity and investigational criteria for Selective Peripheral Denervation (Bertrand procedure) for treatment of spasmodic torticollis (cervical dystonia), lists related and non-covered procedures, and provides applicable CPT/HCPCS/ICD-10 codes and background evidence. Policy number: 0401. Coverage stance: mixed.
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