Attention Deficit/Hyperactivity Disorder (CPB 0426, reviewed 2026-07-07)
Summary
Aetna Clinical Policy Bulletin 0426 sets coverage rules for attention deficit hyperactivity disorder (ADHD). It considers a medical evaluation with a complete medical history and physical examination, a complete psychiatric evaluation for adults, and laboratory evaluation (including CBC and LFT) and cardiac evaluation with an ECG if indicated medically necessary for assessment before beginning stimulant medication therapy, with blood lead level measurement for individuals with risk factors. Pharmacotherapy and behavioral modification are considered medically necessary for treatment of ADHD, and EEG or a neurological consult is medically necessary only when focal signs or clinical findings suggest a seizure disorder or a degenerative neurological condition. Neuropsychological testing is medically necessary only in neurologically complicated cases such as post head trauma or seizures, and psychological testing is not considered medically necessary for children with uncomplicated ADHD. Computerized EEG, neuroimaging, EEG theta/beta power ratio, polygenic risk score testing, acupuncture, chiropractic manipulation, cannabis and neurofeedback are listed as experimental, investigational or unproven for ADHD.
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