Rheumatic Diseases: Selected Tests (CPB 0866, reviewed 2025-12-22)
Summary
Aetna considers HLA-B27 testing medically necessary for diagnosing ankylosing spondylitis and Reiter's syndrome (reactive arthritis), anti-CCP antibodies medically necessary for diagnosing rheumatoid arthritis, a myositis antibody panel medically necessary for diagnosing inflammatory myopathy, and anti-dsDNA antibodies medically necessary for evaluating and managing systemic lupus erythematosus. The UBA1 mutation test (QClamp Plex VEXAS) is medically necessary for detecting VEXAS syndrome in individuals aged 18 years or older who present with clinical features of the syndrome. Aetna considers the listed biomarker tests experimental, investigational or unproven because their effectiveness has not been established, including the aiSLE DX indices, PrismRA, Vectra DA, the Avise tests, anti-MCV antibodies, the Early Sjogren's Syndrome Profile, and anti-CCP antibodies for indications other than rheumatoid arthritis.
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