AetnaAll Plans · Coverage · Medical Policy · OB-GYN, Family MedicineMedium impact
Diagnosis of Vaginitis (CPB 0643, reviewed 2026-09-25)
Effective date
Not stated in the notice
Identified
Oct 1, 2026
Summary
Aetna's vaginitis diagnosis policy (CPB 0643), last reviewed 09/25/2026, considers nucleic acid amplification or DNA probe tests for trichomonas, Candida and Gardnerella medically necessary for members with dysuria or symptoms of vaginitis. It also considers BVBlue sialidase testing, PCR tests for bacterial vaginosis and Candida, and pH and amine testing medically necessary for women with symptoms. Trichomonas screening is considered medically necessary for women with listed risk factors, including HIV-positive women, new or multiple partners, history of sexually transmitted diseases, exchange of sex for payment, injection drug use, or high-prevalence settings. Routine screening of asymptomatic women for Candida and Gardnerella, Pap smears for the diagnosis of Candida vulvovaginitis, the uBiome SmartJane screen and the 27-organism vaginal pathogen panel are experimental, investigational or unproven, and screening asymptomatic pregnant women for bacterial vaginosis is experimental and not covered.
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01Billing team: Bill the vaginitis tests listed as covered only when the selection criteria in the policy are met, such as symptoms of vaginitis or dysuria for the Candida, Gardnerella and trichomonas tests, and one of the listed risk factors for trichomonas screening.
02For PCR tests, the policy states that testing may be performed on either a clinician-collected or an FDA-cleared self-collected vaginal specimen.
03Do not bill routine Candida or Gardnerella screening of asymptomatic women, Pap smears for the diagnosis of Candida vulvovaginitis, the uBiome SmartJane screen, or the 27-organism vaginal pathogen panel (CPT 0330U) as medically necessary, because the policy lists them as experimental, investigational or unproven or as not covered.
04Do not bill screening for bacterial vaginosis in asymptomatic pregnant women, because the policy states it is experimental and not covered.
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