Vulvodynia and Vulvar Vestibulitis Treatments

Aetna covers medically necessary physical therapy (CPT 97010–97139), perineoplasty (56810) and vestibulectomy/vulvectomy procedures (CPT 56620–56640) for vulvodynia/vulvar vestibulitis when selection criteria are met, with vestibulectomy allowed only after failure of conservative measures including vulvar care, physical therapy and pharmacotherapy (analgesics). The policy excludes/considers experimental a long list of interventions (e.g., vestibuloplasty, acupuncture, botulinum toxin, lasers, neuromodulation/pudendal procedures, various topical/compounded agents) and does not cover the specified CPT/HCPCS/J-codes listed for those treatments.

"Members with vulvodynia/vulvar vestibulitis"

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