Complex Regional Pain Syndrome (CRPS)/Reflex Sympathetic Dystrophy (RSD): Diagnosis

Aetna requires the diagnosis of CRPS/RSD to be made clinically by history and physical exam using the Budapest Criteria (preferred for adults) with rapid clinician assessment. Aetna deems antioxidant profile tests, inflammatory biomarker panels (e.g., autoantibodies, CGRP, IL‑6, TNF‑α, etc.), bone SPECT/CT and CT (including HR‑pQCT) experimental/investigational and not covered for diagnosing CRPS.

"Imaging or other studies may be used as additional/ supportive tools to establish the diagnosis in doubtful cases (clinical findings remain the gold standard)."

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