Aetna policies, page 53

Search Aetna's public medical, payment and drug policies by CPT or HCPCS code, keyword or policy number, with links to the payer's own documents. Links open the payer's own document; check its current version before relying on it.

5,481 public policies Substrate tracks for Aetna, by title.

Aetna policies
PolicyDetailsCodesSource
[Pharmacy] PPI Post Limit PA Policy 169-J, 918-J UDR 04-2024 - Pharmacy Clinical Policy Bulletins Aetna Non-Medicare Prescription Drug Plan169-J, 918-J · Commercial—Original policy ↗
[Pharmacy] PPI Post Limit PA Policy 918-J UDR 04-2023 - Pharmacy Clinical Policy Bulletins Aetna Non-Medicare Prescription Drug Plan918-J · Commercial—Original policy ↗
[Pharmacy] Praluent 2519-A Enhanced SGM P2022 - Specialty Pharmacy Clinical Policy Bulletins Aetna Non-Medicare Prescription Drug Plan2519-A · Commercial—Original policy ↗
[Pharmacy] Praluent 2519-A Enhanced SGM P2023 - Specialty Pharmacy Clinical Policy Bulletins Aetna Non-Medicare Prescription Drug Plan2519-A · Commercial—Original policy ↗
[Pharmacy] Praluent 2519-A Enhanced SGM P2023 - Specialty Pharmacy Clinical Policy Bulletins Aetna Non-Medicare Prescription Drug Plan2519-A · Commercial—Original policy ↗
[Pharmacy] Pretomanid PA Policy 3195-A 01-2022 - Pharmacy Clinical Policy Bulletins Aetna Non-Medicare Prescription Drug Plan3195-A · Commercial—Original policy ↗
[Pharmacy] Pretomanid PA Policy 3195-A 01-2022 - Pharmacy Clinical Policy Bulletins Aetna Non-Medicare Prescription Drug Plan3195-A · Commercial—Original policy ↗
[Pharmacy] Pretomanid PA Policy 3195-A 01-2023 - Pharmacy Clinical Policy Bulletins Aetna Non-Medicare Prescription Drug Plan3195-A · Commercial—Original policy ↗
[Pharmacy] Prevymis Limit, Post PA 2805-HJ 01-2024 v2_R - Pharmacy Clinical Policy Bulletins Aetna Non-Medicare Prescription Drug Plan2805-HJ · Commercial—Original policy ↗
[Pharmacy] Prevymis Limit, Post PA 2805-HJ P01-2025 - Pharmacy Clinical Policy Bulletins Aetna Non-Medicare Prescription Drug Plan2805-HJ P01-2025 · Commercial—Original policy ↗
[Pharmacy] Prevymis Limit, Post PA 2805-HJ P01-2026 - Pharmacy Clinical Policy Bulletins Aetna Non-Medicare Prescription Drug Plan2805-HJ P01-2026 · Commercial—Original policy ↗
[Pharmacy] Prevymis Limit, Post PA Policy 2805-HJ UDR 01-2023 v2 - Pharmacy Clinical Policy Bulletins Aetna Non-Medicare Prescription Drug Plan2805-HJ · Commercial—Original policy ↗
[Pharmacy] Prolia 2026-A SGM P2021 - Specialty Pharmacy Clinical Policy Bulletins Aetna Non-Medicare Prescription Drug Plan2026-A · Commercial—Original policy ↗
[Pharmacy] Prolia 2026-A SGM P2022a - Specialty Pharmacy Clinical Policy Bulletins Aetna Non-Medicare Prescription Drug Plan2026-A SGM P2022a · Commercial—Original policy ↗
[Pharmacy] Prolia 2026-A SGM P2023 - Specialty Pharmacy Clinical Policy Bulletins Aetna Non-Medicare Prescription Drug Plan2026-A · Commercial—Original policy ↗
[Pharmacy] Prolia and Biosimilars SGM 2026-A P2024b - Specialty Pharmacy Clinical Policy Bulletins Aetna Non-Medicare Prescription Drug Plan2026-A P2024b · Commercial—Original policy ↗
[Pharmacy] Prolia and Biosimilars SGM 2026-A P2025b - Specialty Pharmacy Clinical Policy Bulletins Aetna Non-Medicare Prescription Drug PlanSGM 2026-A P2025b · Commercial—Original policy ↗
[Pharmacy] Promacta 1928-A SGM P2022 - Specialty Pharmacy Clinical Policy Bulletins Aetna Non-Medicare Prescription Drug Plan1928-A · Commercial—Original policy ↗
[Pharmacy] Promacta 1928-A SGM P2023 - Specialty Pharmacy Clinical Policy Bulletins Aetna Non-Medicare Prescription Drug Plan1928-A · Commercial—Original policy ↗
[Pharmacy] Promacta-Alvaiz 1928-A SGM P2023a - Specialty Pharmacy Clinical Policy Bulletins Aetna Non-Medicare Prescription Drug Plan1928-A SGM P2023a · Commercial—Original policy ↗
[Pharmacy] Promacta-Alvaiz 1928-A SGM P2023a - Specialty Pharmacy Clinical Policy Bulletins Aetna Non-Medicare Prescription Drug Plan1928-A SGM P2023a · Commercial—Original policy ↗
[Pharmacy] Promacta-Alvaiz 1928-A SGM P2023a - Specialty Pharmacy Clinical Policy Bulletins Aetna Non-Medicare Prescription Drug Plan1928-A · Commercial—Original policy ↗
[Pharmacy] Protopic PA Policy 1255-A, 492-A 04-2022 - Pharmacy Clinical Policy Bulletins Aetna Non-Medicare Prescription Drug Plan1255-A, 492-A · Commercial—Original policy ↗
[Pharmacy] Protopic PA Policy 1255-A, 492-A 04-2022 - Pharmacy Clinical Policy Bulletins Aetna Non-Medicare Prescription Drug Plan1255-A, 492-A · Commercial—Original policy ↗
[Pharmacy] Protopic PA Policy 1255-A, 492-A UDR 04-2023 - Pharmacy Clinical Policy Bulletins Aetna Non-Medicare Prescription Drug Plan1255-A, 492-A · Commercial—Original policy ↗
[Pharmacy] Protopic PA Policy 1255-A, 492-A UDR 04-2023 - Pharmacy Clinical Policy Bulletins Aetna Non-Medicare Prescription Drug Plan1255-A, 492-A · Commercial—Original policy ↗
[Pharmacy] Protopic PA Policy 1255-A, 492-A UDR 04-2023 - Pharmacy Clinical Policy Bulletins Aetna Non-Medicare Prescription Drug Plan1255-A, 492-A · Commercial—Original policy ↗
[Pharmacy] Provigil PA with Limit 178-C, 2814-C P01-2025 - Pharmacy Clinical Policy Bulletins Aetna Non-Medicare Prescription Drug Plan178-C, 2814-C P01-2025 · Commercial—Original policy ↗
[Pharmacy] Provigil PA with Limit 178-C, 2814-C P01-2026 - Pharmacy Clinical Policy Bulletins Aetna Non-Medicare Prescription Drug Plan178-C, 2814-C P01-2026 · Commercial—Original policy ↗
[Pharmacy] Provigil PA with Limit Policy 178-C 04-2022 - Pharmacy Clinical Policy Bulletins Aetna Non-Medicare Prescription Drug Plan178-C · Commercial—Original policy ↗
[Pharmacy] Provigil PA with Limit Policy 178-C, 2814-C UDR 04-2023 - Pharmacy Clinical Policy Bulletins Aetna Non-Medicare Prescription Drug Plan178-C, 2814-C · Commercial—Original policy ↗
[Pharmacy] Prudoxin, Zonalon ST with Limit, Post PA 1496-E P04-2026 - Specialty Pharmacy Clinical Policy Bulletins Aetna Non-Medicare Prescription Drug Plan1496-E · Commercial—Original policy ↗
[Pharmacy] Prudoxin, Zonalon ST with Limit, Post PA Policy 1496-E 07-2022 - Pharmacy Clinical Policy Bulletins Aetna Non-Medicare Prescription Drug Plan1496-E · Commercial—Original policy ↗
[Pharmacy] Prudoxin, Zonalon ST with Limit, Post PA Policy 1496-E UDR 07-2023 - Pharmacy Clinical Policy Bulletins Aetna Non-Medicare Prescription Drug Plan1496-E · Commercial—Original policy ↗
[Pharmacy] Pulmozyme 1886-A SGM P2022 - Specialty Pharmacy Clinical Policy Bulletins Aetna Non-Medicare Prescription Drug Plan1886-A · Commercial—Original policy ↗
[Pharmacy] Pulmozyme 1886-A SGM P2023 - Specialty Pharmacy Clinical Policy Bulletins Aetna Non-Medicare Prescription Drug Plan1886-A · Commercial—Original policy ↗
[Pharmacy] Pulmozyme 1886-A SGM P2024 - Specialty Pharmacy Clinical Policy Bulletins Aetna Non-Medicare Prescription Drug Plan1886-A · Commercial—Original policy ↗
[Pharmacy] Purixan 2982-A SGM P2022 - Specialty Pharmacy Clinical Policy Bulletins Aetna Non-Medicare Prescription Drug Plan2982-A · Commercial—Original policy ↗
[Pharmacy] Purixan 2982-A SGM P2023 - Specialty Pharmacy Clinical Policy Bulletins Aetna Non-Medicare Prescription Drug Plan2982-A · Commercial—Original policy ↗
[Pharmacy] Purixan 2982-A SGM P2023 - Specialty Pharmacy Clinical Policy Bulletins Aetna Non-Medicare Prescription Drug Plan2982-A · Commercial—Original policy ↗
[Pharmacy] Purixan 2982-A SGM P2023 - Specialty Pharmacy Clinical Policy Bulletins Aetna Non-Medicare Prescription Drug Plan2982-A · Commercial—Original policy ↗
[Pharmacy] Purixan SGM 2982-A P2024_R - Specialty Pharmacy Clinical Policy Bulletins Aetna Non-Medicare Prescription Drug Plan2982-A P2024_R · Commercial—Original policy ↗
[Pharmacy] Purixan SGM 2982-A P2024_R - Specialty Pharmacy Clinical Policy Bulletins Aetna Non-Medicare Prescription Drug Plan2982-A P2024_R · Commercial—Original policy ↗
[Pharmacy] Qelbree PA 4681-A P12-2025 - Pharmacy Clinical Policy Bulletins Aetna Non-Medicare Prescription Drug Plan4681-A · Commercial—Original policy ↗
[Pharmacy] Qelbree PA Policy 4681-A 12-2022 - Specialty Pharmacy Clinical Policy Bulletins Aetna Non-Medicare Prescription Drug Plan4681-A · Commercial—Original policy ↗
[Pharmacy] Qelbree PA Policy 4681-A UDR 12-2023 - Pharmacy Clinical Policy Bulletins Aetna Non-Medicare Prescription Drug Plan4681-A · Commercial—Original policy ↗
[Pharmacy] Qinlock 3901-A SGM P2021 - Specialty Pharmacy Clinical Policy Bulletins Aetna Non-Medicare Prescription Drug Plan3901-A · Commercial—Original policy ↗
[Pharmacy] Qinlock 3901-A SGM P2021 - Specialty Pharmacy Clinical Policy Bulletins Aetna Non-Medicare Prescription Drug Plan3901-A · Commercial—Original policy ↗
[Pharmacy] Qinlock 3901-A SGM P2021 - Specialty Pharmacy Clinical Policy Bulletins Aetna Non-Medicare Prescription Drug Plan3901-A · Commercial—Original policy ↗
[Pharmacy] Qinlock 3901-A SGM P2021 - Specialty Pharmacy Clinical Policy Bulletins Aetna Non-Medicare Prescription Drug Plan3901-A · Commercial—Original policy ↗

Back to Aetna · Aetna prior authorization CPT list

Disclaimer

The information provided on this page is for general informational purposes only and does not constitute billing, coding, or reimbursement advice. Nothing on this page should be relied upon as a substitute for clinician assessment, professional billing guidance, or as a definitive statement of any payor's billing requirements or policies.

Payor agreements, fee schedules, and billing policies vary and are subject to change. Before submitting any claims related to maternity care services, including claims affected by the 2027 CPT code revisions, please consult the applicable payor agreements, coverage policies, and billing guidelines to confirm current requirements for their specific payor contracts.

Substrate makes no representation or warranty regarding the accuracy, completeness, or timeliness of the payor-specific information presented here. Providers are solely responsible for ensuring that all claims are submitted in accordance with applicable payor requirements, and Substrate assumes no liability for claim denials, underpayments, or other adverse outcomes arising from reliance on this information.