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Aetna's clinical policy bulletin (CPB 0784) now expects documented weight management attempts of at least 6 months before approving GLP-1 coverage on most plans (up from 3 months on some 2025 plans)
As specified in regulations at 419.66(b)(1) through (3), to be eligible for transitional pass-through payment under the OPPS, a device must meet the following criteria: If required by FDA, the device must have received FDA approval or clearance and FDA marketing authorization (except for a device that has received an FDA investigational device exemption (IDE) and has been classified as a Category B device by FDA), or meet another appropriate FDA exemption
Wu Y, Sun L
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