Premenstrual Syndrome and Premenstrual Dysphoric Disorder (CPB 0512, reviewed 2026-08-05)
Aetna's Clinical Policy Bulletin 0512 considers gynecological consultation, a medical evaluation with complete medical history and physical examination, thyroid function tests, cognitive behavioral therapy and bilateral oophorectomy medically necessary for premenstrual syndrome and premenstrual dysphoric disorder, with oophorectomy reserved for severe symptoms when all medical therapy has failed or produced unacceptable side effects. Psychiatric or psychological consultation and testing are medically necessary when the member exhibits mental or nervous symptoms. The policy lists acupuncture, aromatherapy, light therapy, intravenous magnesium, intravenous vitamin B6 and vitamin E, reflexology, vestibular stimulation, endometrial ablation, and several laboratory and neuroimaging tests as experimental, investigational or unproven.