Extracorporeal Membrane Oxygenation (ECMO)

Aetna covers ECMO/ECLS for neonates only when strict selection criteria are met (specific diagnoses such as congenital diaphragmatic hernia, hyaline membrane disease, meconium aspiration, persistent fetal circulation or refractory neonatal septic shock, gestational age ≥34 weeks, birth weight ≥2,000 g, and age <10 days) and for children/adults with severe, potentially reversible respiratory or cardiac failure (e.g., ARDS, bridge to transplant or durable MCS, post‑cardiac surgery, refractory pediatric septic shock) when risk of death is very high despite optimal conventional therapy. ECMO/ECLS is considered experimental/investigational and not covered when those criteria or indications are not met or for listed exclusions/contraindications (e.g., necrotizing pneumonia, multiple organ failure, metastatic disease, major CNS injury, >10 days of mechanical ventilation, many other specified conditions, and most COVID‑19 cases not meeting criteria); covered CPT/ICD‑10 codes apply only if selection criteria are satisfied.