![]() Genetic counseling for parents of a child with autism (see CPB 0189 - Genetic Counseling).Occurrence or adequacy of newborn screening for a birth defect is questionable.Evidence of mental retardation or mental retardation can not be ruled out or.Cyclic vomiting, recurrent vomiting and dehydration.Selective metabolic testing if the child exhibits any of the following:Ĭlinical and physical findings suggestive of a metabolic disorder:.Quantitative plasma amino acid assays to detect phenylketonuria.Parent and/or child interview (including siblings of children with autism).Medical evaluation (complete medical history and physical examination, including neurologic evaluation).Comparative genomic hybridization (CGH), when medical necessity criteria are met in CPB 0787 - Comparative Genomic Hybridization (CGH).Genetic testing specifically high resolution chromosome analysis (karyotype) and DNA analysis for fragile X syndrome in the presence of mental retardation (or if mental retardation can not be excluded) if there is a family history of fragile X or mental retardation of undetermined etiology, or if dysmorphic features are present (see CPB 0140 - Genetic Testing).Measurement of blood lead level if the child exhibits developmental delay and pica, or lives in a high-risk environment (see CPB 0553 - Lead Testing) additional periodic lead screening can be considered if the pica persists.Formal audiological hearing evaluation including frequency-specific brainstem auditory evoked response (see CPB 0181 - Evoked Potential Studies) or otoacoustic emissions.Speech, language and comprehensive communication evaluation by speech-language pathologist.Cognitive and adaptive behaviors evaluations.The following services may be included in the assessment and treatment of the member's condition: This Clinical Policy Bulletin addresses autism spectrum disorders.Īetna 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 when the evaluation is performed by the appropriate certified/licensed health care professional. Number: 0648 Table Of Contents Policy Applicable CPT / HCPCS / ICD-10 Codes Background References
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