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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
Coronary artery disease (CAD)
Diabetes
Hypertension (HTN)
- Guidelines Made Simple|2017 Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults
- USPSTF Hypertension in Adults: Screening April 2021
Immunizations CDC/ACIP Guidelines
Low Back Pain
- Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline from the American College of Physicians (August 2020)
- Diagnosis and Treatment of Low Back Pain (LBP) (2022) VA/DoD Clinical Practice Guidelines
Obesity
- Obesity Medicine 2023
- Behavioral Counseling Interventions to Promote a Healthy Diet and Physical Activity for Cardiovascular Disease Prevention in Adults Without Cardiovascular Disease Risk Factors (July 2022)
Opioids for Chronic Pain CDC Guideline
- CDC’s Clinical Practice Guideline for Prescribing Opioids for Pain | Guidelines | Healthcare Professionals | Opioids | CDC
- Use of Opioids in the Management of Chronic Pain (2022) VA/DoD Clinical Practice Guidelines
Pediatric Preventative Health Care
- Clinical Practice Guideline for the Diagnosis, Evaluation
- Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents
- Identification and Management of Eating Disorders in Children and Adolescents
- Recommendations for Preventive Pediatric Health Care
Prenatal Services
Schizophrenia
Sickle Cell Anemia
Substance Use Disorder
- American Society of Addiction Medicine Consensus Statement — Appropriate Use of Drug Testing in Clinical Addiction Medicine (Reviewed December 2019)
- American Society of Addiction Medicine Treatment of Opioid Use Disorder (2020)
Suicide Prevention
- US Department of Veterans Affairs Assessment and Management of Patients at Risk for Suicide (2019)
- Substance Abuse and Mental Health Services Administration: 988 Suicide & Crisis Lifeline
- FY 2023 National Strategy for Suicide Prevention (samhsa.gov)
Tobacco Cessation
- Cessation Material for State Tobacco Control Programs
- Tobacco and Nicotine Cessation During Pregnancy ACOG. Number 807 (May 2020)
- JNCCN
Trauma Informed Care
HIV/AIDS
Hepatitis C
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
Instructions for Accessing Aetna Supplemental Criteria Guidelines (PDF)