Tourette's Syndrome

Aetna covers assessment and treatment of Tourette's syndrome only when ALL of these are met: multiple motor and ≥1 vocal tics have occurred (not necessarily simultaneously), onset before age 21, tics occur many times daily in bouts for >1 year with no tic‑free period >3 months, cause significant distress or functional impairment, and are not due to a substance or other medical condition. EEG/neurology consults are covered only with focal signs or suspicion of seizure/degenerative disease; self‑administered medications are covered under the pharmacy benefit (formulary limits may apply); most educational interventions are excluded, and specific tests/procedures (e.g., cognitive/motor event‑related potentials, computerized EEG/brain mapping, genetic studies, cytokine/T‑cell assays, ferritin, microRNAs, and neuroimaging such as CT/MRI/PET/SPECT) are considered experimental/investigational.

"ICD-10 code covered when selection criteria are met: F95."