Prolotherapy and Sclerotherapy

Aetna considers prolotherapy (including neural prolotherapy, prolozone, and Sarapin) experimental/investigational and not covered for all indications, while sclerotherapy is accepted for select conditions—active esophageal variceal hemorrhage when endovenous ligation (EVL) has failed or cannot be performed, aneurysmal bone cyst, benign cystic thyroid nodules, HHT-related epistaxis, and Morton's neuroma after failed conservative care. Key requirements: esophageal variceal sclerotherapy is limited to patients who failed or cannot undergo EVL, Morton's neuroma requires prior orthotic use and corticosteroid injections, and numerous other sclerotherapy uses (e.g., Achilles or patellar tendinopathy, hepatic cysts, ovarian endometrioma, prophylactic variceal treatment, seromas, high varix ligation) are specifically considered investigational.

"For ovarian endometrioma: most evidence is from non-randomized studies and retrospective series; optimal technique (aspiration vs retention, dwell time) not established; recurrence rates variable."