Autism Spectrum Disorders (CPB 0648, reviewed 2026-10-20)
Summary
Aetna considers autism spectrum disorder (ASD) evaluation and diagnosis 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 following services may be included in the assessment and treatment of ASD: ASD-specific developmental evaluation, cognitive and adaptive behavior evaluations, speech-language evaluation, formal audiological hearing evaluation, genetic testing within stated criteria, medical evaluation, and pharmacotherapy for co-morbidities subject to the member's drug benefits. The policy lists many assessments and treatments as experimental, investigational, or unproven, including the EarliPoint eye-tracking test, metabolomic blood tests, chelation therapy, and hyperbaric oxygen therapy, and it states that services primarily educational in nature are not covered under medical benefits.
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