Vesicoureteral Reflux Treatment by Endoscopic Injection of Bulking Agents

Aetna covers endoscopic injection of FDA‑approved bulking agents (e.g., Deflux, Macroplastique, Teflon) for primary or secondary VUR when conservative treatments have failed, for children after unsuccessful ureteral re‑implantation, or when medication is stopped due to intolerance or parental noncompliance. It excludes non‑FDA agents (e.g., autologous blood, calcium hydroxyapatite, chondrocytes, fat, Contigen/Zyplast, Bulkamid, Vantris) as experimental/investigational, limits treatment to a maximum of 3 sessions (no further treatment if no improvement), and does not cover specified HCPCS codes L8603 and Q2026.

"For post-transplant cases: documentation of symptomatic VUR after renal transplantation and relevant transplant/graft function data."

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