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Clinical guidelines and policy bulletins

Guidelines

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

Asthma 
 

Asthma Management Guidelines: Focused Updates 2020

 

2020 Focused Updates to the Asthma Management Guidelines

 

Chronic obstructive lung disease (COPD) 
 

Chronic Obstructive Pulmonary Disease (COPD) Guidelines, Reports, and References

 

Congestive heart failure (CHF) 
 

2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure  

 

Coronary artery disease (CAD) 
 

Primary Prevention of CVD Guideline Hub

 

Diabetes
 

American Diabetes Association Practice Guidelines Resources

 

Hepatitis C
 

HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C

 

HIV/AIDS
 

Clinical Care Guidelines and Resources  

 

Hypertension (HTN)
 

2017 Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults

 

Immunizations (CDC/ACIP guidelines)
 

2024 Immunizations Schedules

 

COVID-19 Vaccination Clinical & Professional Resources

 

Low back pain 
 

Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain

 

Diagnosis and Treatment of Low Back Pain (LBP) (2022)   

 

Obesity 
 

Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity

 

Obesity in adults: a clinical practice guideline

 

Opioids for chronic pain (CDC guideline)
 

Use of Opioids in the Management of Chronic Pain (2022)    

 

Pediatric preventive health care 
 

American Academy of Pediatrics Periodicity Schedule (PDF)

 

Prenatal services
 

Ambulatory Adult Prenatal Care Guideline

 

Preventive screenings counseling and preventive medication 
 

U.S. Preventive Services Task Force (USPSTF) 
 

Sickle Cell Anemia 
 

Sickle Cell Disease Clinical Guidelines (CDC)

Alcohol use disorder
 

The ASAM Clinical Practice Guideline on Alcohol Withdrawal Management (PDF)
 

APA Guideline for Treatment of Patients with Alcohol Use Disorder
 

Attention-deficit/hyperactivity disorder (ADHD)
 

Clinical Practice Guideline for the Diagnosis, Evaluation and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents
 

Attention-Deficit/Hyperactivity Disorder (ADHD)
 

Eating disorders
 

Identification and Management of Eating Disorders in Children and Adolescents
 

The APA Guideline for the Treatment of Patients With Eating Disorders
 

Generalized anxiety disorder
 

Anxiety Disorders
 

AACAP Guideline for Assessment and Treatment of Children and Adolescents With Anxiety Disorders
 

Major depressive disorder (APA guidelines)
 

APA Clinical Practice Guideline for the Treatment of Depression Across Three Age Cohorts (PDF)
 

Schizophrenia
 

The American Psychiatric Association Practice Guideline for the Treatment of Patients with Schizophrenia
 

Substance use disorder
 

Appropriate Use of Drug Testing in Clinical Addiction Medicine Consensus Document
 

The ASAM National Practice Guideline for the Treatment of Opioid Use Disorder
 

Suicide prevention
 

VA/DoD Clinical Practice Guidelines
 

988 Suicide & Crisis Lifeline
 

Blueprint for Youth Suicide Prevention
 

Tobacco cessation
 

Cessation Materials for State Tobacco Control Programs
 

Tobacco and Nicotine Cessation During Pregnancy 
 

U.S. Public Health Service Guideline for Treating Tobacco Use and Dependence
 

Trauma-informed care
 

Fostering Resilience and Recovery: A Change Package

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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