Aetna Inc. and its affiliated 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. 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. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. 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. you can call Aetna Better Health of Louisiana Member Services at 1-855-242-0802, TTY 711, 24 hours a day, 7 days a week. This Agreement will terminate upon notice if you violate its terms. 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. 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. This information is neither an offer of coverage nor medical advice. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. The DSNP network is in limited counties. The path to healthy starts here. Our directory PDF (or printed directory) is updated monthly.You can get a copy of the provider directory by mail. CMS requires providers to take the Model of Care training course (PDF). Learn about Aetna Smart Compare. Please correct the following errors and try again: Fill out the form below to find providers and healthcare facilities near you. Each main plan type has more than one subtype. 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. 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. 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. SELECT A DIRECTORY. . The AMA is a third party beneficiary to this Agreement. Prior Authorization may be required. You'll find these doctors with the label "Quality Care," "Effective Care" or both in your search. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. Request an Office Transfer. Links to various non-Aetna sites are provided for your convenience only. 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). 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. Find a Dentist. Find a Provider. System (HCPCS) codes or a CPT group and select SEARCH. For enhanced adults benefit, visit Dental Provider Search to view your dental providers. 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. 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. 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). Note not all Aetna dental plans and offers available in all markets. Copyright document.write(new Date().getFullYear()) Aetna Better Health of Louisiana, All Rights Reserved. * Enter Provider ID : * Enter NPI : *Provider Type : Select a Provider Type Medical (Includes Behavioral Health) Dental Facilities. 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. All Rights Reserved. Go to the American Medical Association Web site. It is only a partial, general description of plan or program benefits and does not constitute a contract. 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. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. logo Aethna Better Health of West Virginia. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Search result definitions: NOTE: When selecting by CPT group, the results displayed include CPT codes where Pediatric Dentists: provide dental care for children and young adults. 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. Members should discuss any matters related to their coverage or condition with their treating provider. The AMA is a third party beneficiary to this Agreement. Please consult with the respective plan detail page for additional plan terms. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. 1. 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. This Agreement will terminate upon notice if you violate its terms. Family planning, Emergent and Urgent Care services do not require PA. Copyright 2015 by the American Society of Addiction Medicine. Directory of Dentists Treating Members with Intellectual . LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). CPT only Copyright 2022 American Medical Association. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. To help us direct your question or comment to the correct area, please select a category below. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. 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). This information is neither an offer of coverage nor medical advice. 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. Be sure to check your email for periodic updates. Filter Type: All Symptom Treatment Nutrition Dental Services Aetna Medicaid New Jersey . What's covered? 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. Learn more about our dental advantages. 2/22). For language services, please call the number on your member ID card and request an operator. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. For language services, please call the number on your member ID card and request an operator. Members should always contact the provider's office in advance to confirm availability. By submitting your information you are agreeing to receive communications from Aetna Dental Offers. You may opt out at any time. You are now being directed to CVS Caremark site. Request an Office Transfer. Treating providers are solely responsible for dental advice and treatment of members. 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). Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. New and revised codes are added to the CPBs as they are updated. If you are in Virginia, check your status by going to the Aetna Better Health of Virginia provider search page. Links to various non-Aetna sites are provided for your convenience only. HMO Plan*; Open Access Plan; QCHP/CDHP Plan; For step-by-step instructions, click on a plan below. 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. Let Customer Service know the providers you called. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. These services include preventive care like cleanings and checkups, along with restorative services such as fillings, root canals, crowns and other treatments for broken or missing teeth. Join today and elevate your smile for less than you ever dreamed was possible. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. Just enter your mobile number and well text you a link to download the Aetna Health app from the App Store or on Google Play. Learn about your health plan or find coverage for you and your family. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. 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.
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