Medium impact
Defecography (CPB 0718, reviewed 2025-10-14)
Aetna·Effective Oct 14, 2025
Aetna's Defecography policy (CPB 0718, effective 2025-10-14) defines strict medical necessity criteria requiring documented chronic constipation AND negative/inconclusive anorectal manometry/balloon expulsion tests PLUS specific anatomical suspicions (rectocele, enterocele, puborectalis dysfunction, or pelvic prolapse) before coverage. Routine constipation evaluation and pre-operative LARS prediction are now explicitly non-covered. MR defecography is only covered for obstructed defecation syndrome when conventional tests are inconclusive.