Autism Spectrum Disorders (CPB 0648, reviewed 2025-10-02)
Summary
Aetna Clinical Policy Bulletin 0648 covers evaluation and treatment of autism spectrum disorder (ASD). ASD evaluation and diagnosis is considered medically necessary when developmental delays or persistent deficits in social communication and social interaction across multiple contexts have been identified and the evaluation is performed by an appropriate certified or licensed health care professional. The services that may be included in assessment and treatment are ASD-specific developmental evaluation, cognitive and adaptive behavior evaluations, speech and language evaluation by a speech-language pathologist, formal audiological hearing evaluation, medical evaluation, and selected genetic and metabolic testing when criteria are met. Intensive educational interventions, pharmacotherapy for co-morbidities, behavior modification for behavioral co-morbidities, and physical and occupational therapy for co-morbid physical impairments may also be included. The policy lists numerous tests and treatments as experimental, investigational, or unproven for ASD.
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