Payer PolicyActive
Carbogen Inhalation Therapy
AETNA-CPB-0428
Aetna
Effective: June 8, 2023
Updated: December 6, 2025
created · Dec 2, 2025
Policy Summary
Carbogen inhalation therapy is considered experimental and investigational and therefore not covered for treatment of bladder cancer, central retinal artery occlusion, cervical cancer, or head and neck cancers (e.g., laryngeal, lip, mucosal melanoma, nasopharyngeal, oral cavity, paranasal sinuses, salivary gland). Coverage would require established effectiveness demonstrated in peer‑reviewed medical literature (the listed indications are not all‑inclusive).
Coverage Criteria Preview
Key requirements from the full policy
"None specified — this Clinical Policy Bulletin does not list any covered indications for carbogen inhalation therapy. (The policy instead lists specific indications for which carbogen inhalation th..."
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