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Clinical guidelines and policy bulletins


Respected professional and public health organizations create clinical practice guidelines that document best practices and recommendations for care. We’ve chosen certain clinical guidelines to help our providers give members high-quality, consistent care with effective use of services and resources. These include treatment protocols for specific conditions, as well as preventive health measures.


The intention of these guidelines is to clarify standards and expectations. They should not: 


  • Take precedence over your responsibility to provide treatment based on the member’s needs
  • Substitute as orders for treatment of a member
  • Guarantee coverage or payment for the type or level of care proposed or provided

Clinical practice guidelines

Adult preventive screenings


Alcohol abuse


Alcohol Use Disorder


American College of Cardiology guidelines


Anxiety Disorder




Attention-deficit/hyperactivity disorder


Behavioral health treatments and services


Breast Cancer


Cancer screenings


Cardiovascular disease and comorbid conditions


Cardiovascular medicine


Chronic obstructive lung disease (COPD)


Congestive Heart Failure


Cognitive impairment


Community reintegration


Coronary Artery Disease


Dental services


Depression in primary care


Diabetes care


Diabetes standards of medical care


Eating Disorder


Elder abuse


Elderly and disabled


Heart failure (ACCF/AHA Guideline)


Heart failure (ACC/AHA/HFSA Focused Update)


Hepatis C


High blood pressure in adults


High blood pressure guidelines made simple




Home and community-based services






Lead (PDF)


Long-term care


Low Back Pain


Major depressive disorder


Medication management (PDF)




Opioids for chronic pain


Pediatric Preventative Health Care


Prenatal care


Prenatal care and deliveries before 39 weeks (may require ACOG membership to access)


Preventive care for Medicaid members


Preventive Screenings, Counseling and Preventive Medication ― USPSTF Guidelines (Pediatric, Adult, Senior)


Prostate Cancer


Postnatal care for mothers and newborns (PDF)


Postpartum care (may require ACOG membership to access)




Sickle Cell Anemia


Substance Use Disorder


Suicide Prevention 


Tobacco cessation


Trauma Informed Care


Vaccine recommendations

Clinical policy bulletins

These bulletins state our policy about the medical necessity or investigational status of medical technologies and other services to help with coverage decisions. A national review team creates the bulletins and bases them on:


  • Published medical literature
  • Formal technology assessments
  • Structured evidence reviews
  • Evidence-based consensus statements
  • Expert opinions
  • Evidence-based guidelines from professional and public health entities 


Aetna® clinical policy bulletins


Aetna medical clinical policy bulletins

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