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.
||Aetna Clinical Policy Bulletin (CPB)
|Homocysteine cardiovascular test (83090)
|Lipoprotein (A) (83695)
|Immunoassay for tumor antigen, quantitative CA 19-9 (86301)
|Infectious agent detection by nucleic acid (DNA or RNA); (87621)
|PCR test for Lyme disease (87476)
|VAP cholesterol test (83701)