Videostroboscopy
This policy governs when videostroboscopy is considered medically necessary or experimental for Aetna members, defining covered diagnostic indications and required prior examinations for vocal cord pathology evaluation.
No material clinical or coverage changes in this revision.
Coverage Criteria: When Videostroboscopy Is Considered Medically Necessary
Medical Necessity (Covered Indication)
Covered when ALL of the following are met
From policy scope requiring both prior exams before videostroboscopy
Policy specifies coverage when prior mirror-image and endoscopic exams are nondiagnostic despite ongoing symptoms
Covered diagnostic indications listed in policy
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