Experimental, investigational lab tests are not covered

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


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