Medium impact
Tourette's Syndrome (CPB 0480, reviewed 2026-07-24)
Aetna·Effective Jul 24, 2026
Aetna updated its Tourette's Syndrome clinical policy (CPB 0480) establishing medical necessity criteria and clearly delineating covered versus experimental/investigational treatments. Covered services include behavioral intervention (CBIT), specific pharmacotherapies, psychotherapy, and limited assessment tools (EEG/neuro consult only with focal signs). Most advanced interventions including deep brain stimulation, transcranial stimulation, neuroimaging, and biomarker testing are classified as experimental and not covered. Billing teams must immediately align claims submission and prior authorization processes to this framework.