At times, members unexpectedly have to pay for lab tests they thought were covered services. Although these tests were ordered by their physicians, these procedures are experimental or investigational based upon evidence-based standards. As a result, they are not covered under the terms of the member’s health plan.
Reminder: Aetna plans do not cover laboratory tests that are considered experimental or investigational, even when these studies are ordered by a participating physician.
The chart below lists some of the most commonly ordered experimental or investigational lab tests.
|Lab Test ||Aetna Clinical Policy Bulletin (CPB)|
|Homocysteine cardiovascular test (83090)|| 0381, 0562|
|Lipoprotein (A) (83695)||0381|
|Immunoassay for tumor antigen, quantitative CA 19-9 (86301)||0352|
|Infectious agent detection by nucleic acid (DNA or RNA); (87621)||0443|
|PCR test for Lyme disease (87476) ||0215, 0650|
|VAP cholesterol test (83701)||0381|