A4375 Insurance Policy Changes

Ostomy Supplies (CPB 0906, reviewed 2025-12-22)

Aetna has issued a comprehensive medical policy (CPB 0906) establishing medical necessity criteria and monthly/semi-annual quantity limits for ostomy supplies across all ostomy types (colostomy, ileostomy, urinary ostomy). The policy specifies maximum allowable units per item, requires documentation to justify quantities exceeding limits, and restricts certain combinations (e.g., no dual use of liquid barriers, no concurrent day/night drainage bags). Claims exceeding documented medical necessity will be denied.