Hypoxic Ischemic Encephalopathy (CPB 0812, reviewed 2025-11-20)
Aetna considers total body cooling and selective head cooling medically necessary for neonates 28 days of age or younger with moderate or severe hypoxic ischemic encephalopathy (HIE). Aetna considers both cooling methods experimental, investigational, or unproven for other indications. The policy also lists adjunctive therapies for HIE, such as erythropoietin and magnesium, and several HIE biomarkers as experimental, investigational, or unproven.