Prior Authorization Review Panel MCO Policy Submission A ...€¦ · Ageusia refers to an absence...

Prior Authorization Review PanelMCO Policy Submission

A separate copy of this form must accompany each policy submitted for review. Policies submitted without this form will not be considered for review.

Plan: Aetna Better Health Submission Date:07/01/2019

Policy Number: 0390 Effective Date:Revision Date: 06/20/2019

Policy Name: Smell and Taste Disorders Diagnosis

Type of Submission – Check all that apply: New Policy Revised Policy* Annual Review – No Revisions

*All revisions to the policy must be highlighted using track changes throughout the document. Please provide any clarifying information for the policy below:

CPB 0390 Smell and Taste Disorders Diagnosis

This CPB has been revised to state that genotyping of the TAS2R38 gene is considered experimental and investigational as a means of diagnosing an unexplained olfactory dysfunction and gustatory dysfunction.

Name of Authorized Individual (Please type or print):

Dr. Bernard Lewin, M.D.

Signature of Authorized Individual:

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(https://www.aetna.com/)

Smell and Taste Disorders: Diagnosis

Clinical Policy Bulletins Medical Clinical Policy Bulletins

Policy History

Last Review

06/20/2019

Effective: 01/09/200

Next Review: 04/10/2020

Review Histor

y

Definitions

Additional Information

Number: 0390

Policy *Please see amendment for Pennsylvania Medicaid at the end of this CPB.

I. Aetna considers certain procedures/services medically necessary for the

evaluations of members with unexplained olfactory dysfunction (e.g.,

anosmia, hyposmia, dysosmia) and gustatory dysfunction (e.g., ageusia,

hypogeusia, dysgeusia):

A. Biopsy of the olfactory mucosa

B. Drug assays and chemical analyses when certain medications or

nutritional deficiencies are the suspected causes of the disorders

C. Electroencephalography (EEG) for members with a history of seizures

D. Hematological tests (e.g., hematocrit count, hemoglobin level, white

blood cell count, urea nitrogen level, creatinine level, glucose level,

erythrocyte sedimentation rate, eosinophil count, and immunoglobulin E

level)

E. Medical evaluation (complete medical history and physical examination)

F. Nasal endoscopy

G. Neuroimaging with computed tomography (CT) or magnetic resonance

imaging (MRI) to rule out an intra-cranial or peripheral nerve

abnormality

http://www.aetna.com/cpb/medical/data/300_399/0390.html 06/28/2019

http://www.aetna.com/cpb/medical/data/300_399/0390.html

https://www.aetna.com/

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H. Neurological consultation

I. Otolaryngological consultation

J. Psychiatrical consultation

K. Standard taste tests such as Taste-Threshold Test (also known as Whole-

Mouth Taste-Threshold Test), Taste-Suprathreshold Test, Taste-Quadrant

Test, and Flavor Discrimination Test (for evaluation of both taste and

smell sensation)

L. Standardized olfactory tests such as the University Of Pennsylvania

Smell Identification Test (UPSIT) or “Sniffin' Sticks”, the University of

Connecticut Test Battery, the Pocket Smell Test, or the Brief Smell

Identification Test. Other tests include Smell-Threshold Test, Smell-

Suprathreshold Test, and Smell Unilateral Test. For use of olfactory

testing in Parkinson disease,

see CPB 0307 - Parkinson's Disease (0307.html)

M. Thyroid function studies.

Note: An initial and follow-up visit is considered medically necessary for

smell and/or taste dysfunction testing. Additional visits for testing are

considered not medically necessary.

Note: Members with taste loss may need smell testing in addition to taste

testing.

II. Aetna considers the following services as a means of diagnosing an

unexplained olfactory dysfunction and gustatory dysfunction experimental

and investigational because the peer-reviewed medical literature does not

support the use of these studies for this indication:

A. Electrogustometry

B. Genotyping of the TAS2R38 gene

C. Measurement of nasal nitric oxide levels

D. Olfactometry

E. Olfactory and gustatory event potentials

(see CPB 0181 - Evoked Potential Studies (../100_199/0181.html))

F. Positron emission tomography (PET)

(see CPB 0071 - Positron Emission Tomography (PET) (../1_99/0071.html))



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G. Rhinomanometry

(see CPB 0700 - Rhinometry and Rhinomanometry (../700_799/0700.html))

H. Rhinometry (also known as acoustic rhinometry)

(see CPB 0700 - Rhinometry and Rhinomanometry (../700_799/0700.html))

I. Single photon emission computed tomography (SPECT)

CPB 0376 - Single Photon Emission Computed Tomography (SPECT)

(see (0376.html) )

J. Tests for Helicobacter pylori infection.

Background

Normal olfactory and gustatory functioning plays a key role in nutrition and food

selection, and thus is important for the maintenance of a good quality of life. Smell

and taste are closely inter-related. An impairment of the function of one sense

often affects the function of the other sense. In fact, complaints of gustatory loss

usually reflect smell rather than taste dysfunction. Deficits in these senses not only

can reduce the pleasure and comfort from food, but can also lead to food poisoning

or over-exposure to environmentally hazardous agents that are otherwise

detectable by smell and taste.

More than 2 millions Americans suffer from smell and taste disorders. Olfactory

dysfunction is more common than gustatory dysfunction because of the

vulnerability and anatomical distinctiveness of the olfactory system, and because a

decline in olfactory function is part of the normal aging process. Common olfactory

and gustatory disturbances could be the consequence of a variety of medications,

upper respiratory infections, nasal and paranasal sinus diseases, depression,

hypothyroidism, and damage to peripheral nerves supplying smell and taste. In

particular, inflammation (nasal and sinus disease), viral infection, and head trauma

are the most frequent causes of smell disorders; while oral and perioral infections

(e.g., gingivitis and candidiasis), oral appliances (e.g., dentures and filling

materials), dental procedures and Bell's palsy are the most common causes of

taste disorders.



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Anosmia refers to an absence of the smell sensation; hyposmia is defined as

reduced sensitivity to odorants (odor stimuli), and dysosmia refers to an altered

perception of smell. Dysosmia can be further classified into phantosmia (a

perception of an odor without the stimulus present) and parosmia or troposmia (an

altered perception of an odor with a stimulus present).

Ageusia refers to an absence of the taste sensation; hypogeusia is defined as

reduced sensitivity to tastants (taste stimuli), and dysgeusia refers to an altered

perception to taste with or without the presence of a tastant.

A careful medical history of systemic illnesses and medication use as well as a

thorough physical examination are essential for the diagnosis of smell and taste

disorders. Work-up should not commence until a standardized test such as the

University of Pennsylvania Smell Identification Test (UPSIT) or the University of

Connecticut Test Battery has been given to establish impairment of the sense of

smell. The University of Pennsylvania Smell Identification Test (UPSIT) is an

objective, quantitative test of olfactory function. The test consists of 40 odors, each

of which is microencapsulated on a pad that, one at a time, the patient scratches

with a pencil and sniffs. The patient is provided with a list of 4 choices for each

pad, and from which the correct answer must be chosen or a guess made. It has

been demonstrated that there is good correlation between UPSIT and other

olfactory function tests such as the T&T olfactometer threshold test, Cain's odor

identification test, and Le Nez du Vin-derived smell identification test. Furthermore,

it has been reported that the UPSIT and its 10-, 20-, and 30-item fragments have

very high internal consistency reliability.

The recent practice parameter on diagnosis and prognosis of new onset Parkinson

disease by the American Academy of Neurology (Suchowersky et al, 2006) stated

that olfactory testing using either the UPSIT or “Sniffin' Sticks” should be

considered to differentiate progressive supranuclear palsy and corticobasal

degeneration from Parkinson's disease.

Nasal mucous membranes should be examined for abnormal conditions. Biopsy is

necessary if intra-nasal or intra-oral neoplasm is suspected to be the cause of the

dysfunction. Furthermore, intra-nasal biopsy is also helpful in diagnosing post-

upper respiratory infection-induced olfactory loss. Drug assays, chemical analyses

and thyroid function studies may be necessary since distortion of chemosensory

sensations are associated with the use of certain medications (e.g., anti-



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depressants and anti-convulsants, anti-psychotics, anti-hypertensives and cardiac

medications, lipid-lowering agents, and anti-Parkinsonian agents), nutritional

deficiency (e.g., zinc deficiency), and thyroid disease.

Neuroimaging such as CT or MRI may be necessary to rule out intra-cranial or

peripheral nerve abnormalities. Computed tomography is useful in imaging the

nasal and sinus cavities, skull base, olfactory cleft, nasopharynx, parotid,

oropharynx, neck, and mandible. Bone abnormalities and widening of cranial nerve

foramina are best observed with CT. Magnetic resonance imaging is useful in

evaluating the olfactory bulbs, ventricles, other soft tissues in the brain, soft tissues

of the tongue, tongue base, blood vessels and nerves in the skull base and neck.

Studies such as SPECT and PET do not play a significant role in the diagnosis of

olfactory and gustatory dysfunctions. Patients with a history of seizure disorder

should be referred for EEG. Otolaryngological, neurological, and psychiatrical

consultation may be necessary if the underlying cause of the olfactory/gustatory

dysfunction is diagnosed as a condition, which may require further evaluation and

treatment, by a specialist in such discipline.

Ellegard and colleagues (2007) examined if electrogustometry is useful for

screening abnormalities of taste. These investigators asked 114 subjects, some

healthy but most with medical conditions possibly affecting taste, to rate their

overall taste ability, on a scale of 0 to 10. Those who had current symptoms related

to taste, and who rated their taste as 5 or worse were defined as "aberrant tasters".

These researchers recorded automated electrogustometry thresholds, and visual

analog scale intensity ratings, for solutions of the four basic tastes (sweet, sour,

salty and bitter). A visual analog scale score of 50 was used as a cut-off point to

identify "poor tasters". The sensitivity and specificity of electrogustometry in

identifying abnormal taste function were low. The authors concluded that

automated electrogustometry is not a useful clinical screening method for taste

disturbance in this group of subjects.

There is insufficient scientific evidence to support the usefulness of olfactory

evoked potentials, olfactometry, rhinometry, rhinomanometry, or electrogustometry

in the diagnosis of smell and taste disorders.

Cecchini and colleagues (2013) stated that Helicobacter pylori (H. pylori) has been

found in dental plaque, saliva and lingual sites. To-date, taste or olfaction disorders

related to H. pylori infections have never been reported. In a review of the literature



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these researchers found 2 papers just referring to a sour taste sensation during H.

pylori infection. Studies in animal models suggested that changes in taste

perception may relate to infections that damage taste buds. These investigators

observed an interesting clinical case of a 24-year old Ghanaian woman with

documented H. pylori gastric infection, complaining of cacosmia and cacogeusia.

Taste evaluation indicated hypogeusia and high-lighted a specific difficulty in

discriminating between bitter and acid tastes. Saliva fluid was found positive for the

ureA gene (H. pylori ureasi A). On the basis of this report, the authors

hypothesized that taste perception might be correlated with a documented H. pylori

infection. So, in a dyspeptic clinical picture in both pre- and post-diagnostic phase

when H. pylori infection is suspected, taste evaluation might be important.

Moreover, they stated that further studies are certainly needed in a large patient

population to clarify the possible connection between H. pylori infection and smell-

taste distortion.

In a prospective study, Elsherif et al (2007) examined the relationship between

nasal nitric oxide (nNO) concentration and its influence on olfactory function. A

total of 64 patients suffering from chronic rhinosinusitis and 20 healthy subjects

participated in this study. The nNO concentration was measured by

chemiluminescence and olfactory thresholds were measured with the phenyl

ethanol threshold of the Sniffin' Sticks. In chronic rhinosinusitis patients this

measure was done pre-operatively and 3 months after endoscopic sinus surgery.

Healthy subjects had significantly higher nNO concentrations and better olfactory

thresholds compared to the chronic rhinosinusitis patients, both before and after

those had undergone sinus surgery. Olfactory thresholds and nNO concentrations

remained unchanged after surgery in the chronic rhinosinusitis group. In the

chronic rhinosinusitis group, nNO concentrations correlated positively with the

olfactory threshold pre-operatively (p < 0.0001) and 3 months after surgery (p <

0.05). In the control group, nNO production did not correlate with the olfactory

thresholds (p > 0.05). The authors concluded that olfactory function and nNO

concentration correlated in chronic rhinosinusitis patients but not in healthy

subjects. This suggested that both parameters do rather not directly influence each

other but it might be the inflammatory processes found in chronic rhinosinusitis that

affects olfaction and nNO. They stated that nNO produced by the paranasal

sinuses appeared not to directly influence olfactory function.



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Gupta and associates (2013) stated that nNO and olfactory function are decreased

in patients with chronic inflammatory sinonasal disease, suggesting a link between

these 2 parameters. These researchers examined nNO levels in patients with

olfactory dysfunction due to different causes. Post-traumatic (n = 11), idiopathic (n

= 13), and sinonasal-related olfactory-impaired patients (n = 55) were compared

with healthy subjects (n = 11). Nasal NO levels, olfactory testing (Sniffin' Sticks),

and rhino-sinusitis questionnaires (Short-Form 36, Sinonasal Outcome Test 22,

Rhinosinusitis Disability Index) were obtained. No significant difference in nNO

levels were found between the different olfactory dysfunction causes. Nasal NO

correlated negatively with age and positively with overall olfactory function, olfactory

discrimination, and identification but not with olfactory thresholds. The more nasal

symptoms prevailed in the Rhinosinusitis Disability Index, the lower the nNO. The

authors concluded that nNO levels did not allow for discrimination between

olfactory loss due to various etiologies based on the present data. Nasal NO

production appeared to decrease with age and also seemed to be associated to

overall olfactory function and in particular to central nervous system tasks such as

olfactory discrimination and identification but not to olfactory thresholds. The

authors stated that these findings raised questions about the link and interaction

between olfactory function and nNO.

Genotyping of the TAS2R38 Gene for Taste Disorders

Melis and colleagues (2019) noted that taste sensitivity varies greatly among

individuals influencing eating behavior and health, consequently the disorders of

this sense can affect the quality of life (QOL). The ability to perceive the bitter of

thiourea compounds, such as phenylthiocarbamide (PTC), has been largely

reported as a marker of the general taste sensitivity, food preferences, and health.

PTC sensitivity is mediated by the TAS2R38 receptor and its genetic common

variants. In a prospective, cohort study, these researchers examined the role of the

TAS2R38 receptor in taste disorders with the aim of understanding if these could

be genetically determined. Differences in the PTC responsiveness between the

patients cohort and healthy controls were examined. All subjects received

standardized tests for smell and taste function and were genotyped for the

TAS2R38 gene. PAV/PAV homozygous patients gave high PTC ratings, whereas

PAV/AVI genotypes reported lower values, which were similar to those determined

in AVI/AVI or rare genotypes. In addition, the patients cohort did not meet the Hardy-

Weinberg equilibrium at the TAS2R38 locus, showing a very low frequency of

subjects carrying the PAV/AVI diplotype. Independently, in healthy controls who



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were in equilibrium at the locus, PAV/PAV homozygous and heterozygous rated

PTC bitterness higher compared to AVI/AVI or rare genotypes. The authors

concluded that these findings, by showing that an only taster haplotype (PAV) was

insufficient to evoke high responses of TAS2R38 receptor in patients with taste

disorders, suggest that the genetic constitution may represent a risk factor for the

development of taste disorders.

Furthermore, an UpToDate review on “Evaluation and treatment of taste and smell

disorders” (Mann and Lafreniere, 2019) does not mention genetic testing as a

management tool.

CPT Codes / HCPCS Codes / ICD-10 Codes

Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":

CPT codes covered if selection criteria are met:

30100 Biopsy, intranasal

31231 Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)

70450 Computed tomography head or brain; without contrast material

70460 with contrast material(s)

70470 without contrast material, followed by contrast material(s) and further

sections

70496 Computed tomographic angiography, head, with contrast material(s),

including noncontrast images, if performed, and image postprocessing

70551 Magnetic resonance (e.g., proton) imaging, brain (including brain stem);

without contrast material

70552 with contrast material(s)

70553 without contrast material, followed by contrast material(s) and further

sequences

82565 Creatinine; blood

82947 Glucose; quantitative, blood (except reagent strip)

84443 Thyroid stimulating hormone (TSH)



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Code Code Description

84520 Urea nitrogen; quantitative

85014 Blood count; hematocrit (Hct)

85018 hemoglobin (Hgb)

85032 manual cell count (erythrocyte, leukocyte, or platelet) each

85048 leukocyte (WBC), automated

85651 - 85652 Sedimentation rate, erythrocyte

86003 Allergen specific IgE; quantitative or semiquantitative, each allergen

CPT codes not covered for indications listed in the CPB:

Genotyping of the TAS2R38 gene - no specific code:

78267 Urea breath test, C-14 (isotopic); acquisition for analysis [Helicobacter

pylori]

78268 analysis [Helicobacter pylori]

78607 Brain imaging, tomographic (SPECT)

78608 Brain imaging, positron emission tomography (PET); metabolic

evaluation

83013 Helicobacter pylori; breath test analysis for urease activity, non-

radioactive isotope (eg, C-13)

83014 drug administration

87338 Infectious agent antigen detection by immunoassay technique, (eg,

enzyme immunoassay [EIA], enzyme-linked immunosorbent assay

[ELISA], immunochemiluminometric assay [IMCA]) qualitative or

semiquantitative, multiple-step method; Helicobacter pylori, stool

92512 Nasal function studies (e.g., rhinomanometry)

95012 Nitric oxide expired gas determination

Other CPT codes related to the CPB:

31233 Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via

inferior meatus or canine fossa puncture)

31235 Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via

puncture of sphenoid face or cannulation of ostium)

31237 Nasal/sinus endoscopy, surgical; with biopsy, polypectomy, or

debridement (separate procedure)

80150 - 80202 Therapeutic drug assays



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ICD-10 codes covered if selection criteria are met:

R43.0 - R43.9

The above policy is based on the following references:

1. Kondo H, Matsuda T, Hashiba M, Baba S. A study of the relationship between

the T&T olfactometer and the University of Pennsylvania Smell Identification

Test in a Japanese population. Am J Rhinol. 1998;12(5):353-358.

2. Downey LL, Jacobs JB, Lebowitz RA. Anosmia and chronic sinus disease.

Otolaryngol Head Neck Surg. 1996;115(1):24-28.

3. McMahon C, Scadding GK. Le Nez du Vin -- a quick test of olfaction. Clin

Otolaryngol 1996;21(3):278-280.

4. Doty RL, Frye RE, Agrawal U. Internal consistency reliability of the

fractionated and whole University of Pennsylvania Smell Identification

Test. Percept Psychophys. 1989;45(5):381-384.

5. Doty RL Shaman P, Kimmelman CP, Dann MS. University of Pennsylvania

Smell Identification Smell Test: A rapid quantitative of olfactory function

test for the clinic. Laryngoscope. 1984;94(2 Pt 1):176-178.

6. Ballenger JJ. Clinical anatomy and physiology of the nose and paranasal

sinuses. In: Otolaryngology: Head and Neck Surgery. 15th ed. JJ Ballenger,

JB Snow, Jr, eds. Baltimore, MD: Williams & Wilkins; 1996; Ch. 1: 3-18.

7. Bromley SM. Smell and taste disorders: A primary care approach. Am Fam

Physician. 2000;61(2):427-436, 438.

8. Cullen MM, Leopold DA. Disorders of smell and taste. Med Clin North Am.

1999;83(1):57-74.

9. Spielman AI. Chemosensory function and dysfunction. Crit Rev Oral Biol

Med. 1998;9(3):267-291.

10. Schiffman SS. Taste and smell losses in normal aging and disease. JAMA.

1997;278(16):1357-1362.



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11. Davidson TM, Murphy C, Jalowayski AA. Smell impairment. Can it be

reversed? Postgrad Med. 1995;98(1):107-109, 112-118.

12. Hill DP, Jafek BW. Initial otolaryngologic assessment of patients with taste

and smell disorders. Ear Nose Throat J. 1989;68(5):362, 365-366, 368,

passim.

13. Riechelmann H, O'Connell JM, Rheinheimer MC, et al. The role of acoustic

rhinometry in the diagnosis of adenoidal hypertrophy in pre-school

children. Eur J Pediatr. 1999;158(1):38-41.

14. Kim CS, Moon BK, Jung DH, Min YG. Correlation between nasal obstruction

symptoms and objective parameters of acoustic rhinometry and

rhinomanometry. Auri Nasus Larynx. 1998;25(1):45-48.

15. Tai CF, Ho KY, Hasegawa M. Evaluating the sensation of nasal obstruction

with acoustic rhinometry and rhinomanometry. Kao Hsiung I Hsueh Ko

Hsueh Tsa Chih. 1998;14(9):548-553.

16. Reber M, Rahm F, Monnier P. The role of acoustic rhinometry in the pre

and postoperative evaluation of surgery for nasal obstruction. Rhinology.

1998;36(4):184-187.

17. Yaniv E, Hadar T, Shvero J, Raveh E. Objective and subjective nasal airflow.

Am J Otolaryngol. 1997;18(1):29-32.

18. Goodspeed RB, Gent JF, Catalanotto FA. Chemosensory dysfunction.

Clinical evaluation results from a taste and smell clinic. Postgrad Med.

1987;81(1):251-257, 260.

19. Mann NM. Management of smell and taste problems. Cleve Clin J Med.

2002;69(4):329-336.

20. Tomita H, Ikeda M. Clinical use of electrogustometry: Strengths and

limitations. Acta Otolaryngol Suppl. 2002;(546):27-38.

21. Lobb B, Elliffe DM, Stillman JA. Reliability of electrogustometry for the

estimation of taste thresholds. Clin Otolaryngol. 2000;25(6):531-534.

22. Wrobel BB, Leopold DA. Clinical assessment of patients with smell and

taste disorders. Otolaryngol Clin North Am. 2004;37(6):1127-1142.

23. Suchowersky O, Reich S, Perlmutter J, et al. Practice parameter: Diagnosis

and prognosis of new onset Parkinson disease (an evidence-based review).

Report of the Quality Standards Subcommittee of the American Academy

of Neurology. Neurology. 2006;66:968-975.

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abnormalities of taste? J Laryngol Otol. 2007;121(12):1161-1164.



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25. Kranick SM, Duda JE. Olfactory dysfunction in Parkinson's disease.

Neurosignals. 2008;16(1):35-40.

26. Herting B, Bietenbeck S, Scholz K, et al. Olfactory dysfunction in

Parkinson's disease: Its role as a new cardinal sign in early and differential

diagnosis. Nervenarzt. 2008;79(2):175-184.

27. Mueller CA, Khatib S, Naka A, et al. Clinical assessment of gustatory

function before and after middle ear surgery: A prospective study with a

two-year follow-up period. Ann Otol Rhinol Laryngol. 2008;117(10):769

773.

28. Schuster B, Iannilli E, Gudziol V, Landis BN. Gustatory testing for clinicians.

B-ENT. 2009;5 Suppl 13:109-113.

29. Epstein JB, Barasch A. Taste disorders in cancer patients: Pathogenesis,

and approach to assessment and management. Oral Oncol. 2010;46(2):77

81.

30. Steinbach S, Hundt W, Zahnert T, et al. Gustatory and olfactory function in

breast cancer patients. Support Care Cancer. 2010;18(6):707-713.

31. Lang CJ, Schwandner K, Hecht M. Do patients with motor neuron disease

suffer from disorders of taste or smell? Amyotroph Lateral Scler. 2011;12

(5):368-371.

32. Goldzak-Kunik G, Friedman R, Spitz M, et al. Intact sensory function in

anorexia nervosa. Am J Clin Nutr. 2012;95(2):272-282.

33. Fasunla JA, Hundt W, Lutz J, et al. Evaluation of smell and taste in patients

with Wegener's granulomatosis. Eur Arch Otorhinolaryngol. 2012;269

(1):179-186.

34. Elsherif HS, Landis BN, Hamad MH, et al. Olfactory function and nasal

nitric oxide. Clin Otolaryngol. 2007;32(5):356-360.

35. Cecchini MP, Pellegrini C, Bassetto MA, et al. Might Helicobacter pylori

infection be associated with distortion on taste perception? Med

Hypotheses. 2013;81(3):496-499.

36. Gupta N, Drusch J, Landis BN, Hummel T. Nasal nitric oxide levels do not

allow for discrimination between olfactory loss due to various etiologies.

Laryngoscope. 2013;123(2):311-314.

37. Schriever VA, Mori E, Petters W, et al. The "Sniffin' Kids" test -- a 14-item

odor identification test for children. PLoS One. 2014;9(6):e101086.

38. Sorokowska A, Albrecht E, Haehner A, Hummel T. Extended version of the

"Sniffin' Sticks" identification test: Test-retest reliability and validity. J

Neurosci Methods. 2015;243:111-114.



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39. Mann NM, Lafreniere D. Evaluation and treatment of taste and smell

disorders. UpToDate [online serial]. Waltham, MA: UpToDate; reviewed

February 2019.

40. Melis M, Grzeschuchna L, Sollai G, et al. Taste disorders are partly

genetically determined: Role of the TAS2R38 gene, a pilot study.

Laryngoscope. 2019 Jan 23 [Epub ahead of print].



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Copyright Aetna Inc. All rights reserved. Clinical Policy Bulletins are developed by Aetna to assist in administering plan

benefits and constitute neither offers of coverage nor medical advice. This Clinical Policy Bulletin contains only a partial,

general description of plan or program benefits and does not constitute a contract. Aetna does not provide health care

services and, therefore, cannot guarantee any results or outcomes. Participating providers are independent contractors in

private practice and are neither employees nor agents of Aetna or its affiliates. Treating providers are solely responsible

for medical advice and treatment of members. This Clinical Policy Bulletin may be updated and therefore is subject to

change.

Copyright © 2001-2019 Aetna Inc.



AETNA BETTER HEALTH® OF PENNSYLVANIA

Amendment to Aetna Clinical Policy Bulletin Number: 0390 Smell and

Taste Disorders Diagnosis

There are no amendments for Medicaid.

www.aetnabetterhealth.com/pennsylvania revised 06/20/2019

http://www.aetnabetterhealth.com/pennsylvania

Prior Authorization Review Panel MCO Policy Submission A ...€¦ · Ageusia refers to an absence...

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