Aetna prior authorization and CPT code lookup, page 10
CPT code lookup
Each row is one code from the participating-provider precertification list. This is not a coding dictionary, and it is not a coverage decision. The description is the service name on that list.
Participating-provider outpatient list
Inpatient, emergency, and observation settings are outside this outpatient list. This page does not publish a determination for those settings.
Prior authorization codes
| Code | Description | Source |
|---|---|---|
| 63011 | Spinal procedures: Cervical, lumbar and thoracic laminectomy and/or laminotomy procedures* | Participating provider precertification list for Aetna, Pg 13 Original policy |
| 63012 | Spinal procedures: Cervical, lumbar and thoracic laminectomy and/or laminotomy procedures* | Participating provider precertification list for Aetna, Pg 13 Original policy |
| 63015 | Spinal procedures: Cervical, lumbar and thoracic laminectomy and/or laminotomy procedures* | Participating provider precertification list for Aetna, Pg 13 Original policy |
| 63016 | Spinal procedures: Cervical, lumbar and thoracic laminectomy and/or laminotomy procedures* | Participating provider precertification list for Aetna, Pg 13 Original policy |
| 63017 | Spinal procedures: Cervical, lumbar and thoracic laminectomy and/or laminotomy procedures* | Participating provider precertification list for Aetna, Pg 13 Original policy |
| 63020 | Spinal procedures: Cervical, lumbar and thoracic laminectomy and/or laminotomy procedures* | Participating provider precertification list for Aetna, Pg 13 Original policy |
| 63030 | Spinal procedures: Cervical, lumbar and thoracic laminectomy and/or laminotomy procedures* | Participating provider precertification list for Aetna, Pg 13 Original policy |
| 63032 | Spinal procedures: Cervical, lumbar and thoracic laminectomy and/or laminotomy procedures* | Participating provider precertification list for Aetna, Pg 13 Original policy |
| 63035 | Spinal procedures: Cervical, lumbar and thoracic laminectomy and/or laminotomy procedures* | Participating provider precertification list for Aetna, Pg 13 Original policy |
| 63040 | Spinal procedures: Cervical, lumbar and thoracic laminectomy and/or laminotomy procedures* | Participating provider precertification list for Aetna, Pg 13 Original policy |
| 63042 | Spinal procedures: Cervical, lumbar and thoracic laminectomy and/or laminotomy procedures* | Participating provider precertification list for Aetna, Pg 13 Original policy |
| 63043 | Spinal procedures: Cervical, lumbar and thoracic laminectomy and/or laminotomy procedures* | Participating provider precertification list for Aetna, Pg 13 Original policy |
| 63044 | Spinal procedures: Cervical, lumbar and thoracic laminectomy and/or laminotomy procedures* | Participating provider precertification list for Aetna, Pg 13 Original policy |
| 63045 | Spinal procedures: Cervical, lumbar and thoracic laminectomy and/or laminotomy procedures* | Participating provider precertification list for Aetna, Pg 13 Original policy |
| 63046 | Spinal procedures: Cervical, lumbar and thoracic laminectomy and/or laminotomy procedures* | Participating provider precertification list for Aetna, Pg 13 Original policy |
| 63047 | Spinal procedures: Cervical, lumbar and thoracic laminectomy and/or laminotomy procedures* | Participating provider precertification list for Aetna, Pg 13 Original policy |
| 63048 | Spinal procedures: Cervical, lumbar and thoracic laminectomy and/or laminotomy procedures* | Participating provider precertification list for Aetna, Pg 13 Original policy |
| 63050 | Spinal procedures: Cervical, lumbar and thoracic laminectomy and/or laminotomy procedures* | Participating provider precertification list for Aetna, Pg 13 Original policy |
| 63051 | Spinal procedures: Cervical, lumbar and thoracic laminectomy and/or laminotomy procedures* | Participating provider precertification list for Aetna, Pg 13 Original policy |
| 63052 | Spinal procedures: Cervical, lumbar and thoracic laminectomy and/or laminotomy procedures* | Participating provider precertification list for Aetna, Pg 13 Original policy |
| 63053 | Spinal procedures: Cervical, lumbar and thoracic laminectomy and/or laminotomy procedures* | Participating provider precertification list for Aetna, Pg 13 Original policy |
| 63055 | Spinal procedures: Cervical, lumbar and thoracic laminectomy and/or laminotomy procedures* | Participating provider precertification list for Aetna, Pg 13 Original policy |
| 63056 | Spinal procedures: Cervical, lumbar and thoracic laminectomy and/or laminotomy procedures* | Participating provider precertification list for Aetna, Pg 13 Original policy |
| 63057 | Spinal procedures: Cervical, lumbar and thoracic laminectomy and/or laminotomy procedures* | Participating provider precertification list for Aetna, Pg 13 Original policy |
| 63064 | Spinal procedures: Cervical, lumbar and thoracic laminectomy and/or laminotomy procedures* | Participating provider precertification list for Aetna, Pg 13 Original policy |
| 63066 | Spinal procedures: Cervical, lumbar and thoracic laminectomy and/or laminotomy procedures* | Participating provider precertification list for Aetna, Pg 13 Original policy |
| 63075 | Spinal procedures: Cervical, lumbar and thoracic laminectomy and/or laminotomy procedures* | Participating provider precertification list for Aetna, Pg 13 Original policy |
| 63076 | Spinal procedures: Cervical, lumbar and thoracic laminectomy and/or laminotomy procedures* | Participating provider precertification list for Aetna, Pg 13 Original policy |
| 63077 | Spinal procedures: Cervical, lumbar and thoracic laminectomy and/or laminotomy procedures* | Participating provider precertification list for Aetna, Pg 13 Original policy |
| 63078 | Spinal procedures: Cervical, lumbar and thoracic laminectomy and/or laminotomy procedures* | Participating provider precertification list for Aetna, Pg 13 Original policy |
| 63200 | Spinal procedures: Cervical, lumbar and thoracic laminectomy and/or laminotomy procedures* | Participating provider precertification list for Aetna, Pg 13 Original policy |
| 63265 | Spinal procedures: Cervical, lumbar and thoracic laminectomy and/or laminotomy procedures* | Participating provider precertification list for Aetna, Pg 13 Original policy |
| 63266 | Spinal procedures: Cervical, lumbar and thoracic laminectomy and/or laminotomy procedures* | Participating provider precertification list for Aetna, Pg 13 Original policy |
| 63267 | Spinal procedures: Cervical, lumbar and thoracic laminectomy and/or laminotomy procedures* | Participating provider precertification list for Aetna, Pg 13 Original policy |
| 22818 | Spinal procedures: Kyphectomy* | Participating provider precertification list for Aetna, Pg 13 Original policy |
| 22819 | Spinal procedures: Kyphectomy* | Participating provider precertification list for Aetna, Pg 13 Original policy |
| 63185 | Spinal procedures: Laminectomy with rhizotomy | Participating provider precertification list for Aetna, Pg 13 Original policy |
| 63190 | Spinal procedures: Laminectomy with rhizotomy | Participating provider precertification list for Aetna, Pg 13 Original policy |
| 22850 | Spinal procedures: Removal of spinal instrumentation | Participating provider precertification list for Aetna, Pg 13 Original policy |
| 22852 | Spinal procedures: Removal of spinal instrumentation | Participating provider precertification list for Aetna, Pg 13 Original policy |
| 22855 | Spinal procedures: Removal of spinal instrumentation | Participating provider precertification list for Aetna, Pg 13 Original policy |
| C1821 | Spinal procedures (continued): Spinal fusion surgery | Participating provider precertification list for Aetna, Pg 14 Original policy |
| 22102 | Spinal procedures (continued): Spinal fusion surgery | Participating provider precertification list for Aetna, Pg 14 Original policy |
| 22103 | Spinal procedures (continued): Spinal fusion surgery | Participating provider precertification list for Aetna, Pg 14 Original policy |
| 22210 | Spinal procedures (continued): Spinal fusion surgery | Participating provider precertification list for Aetna, Pg 14 Original policy |
| 22212 | Spinal procedures (continued): Spinal fusion surgery | Participating provider precertification list for Aetna, Pg 14 Original policy |
| 22214 | Spinal procedures (continued): Spinal fusion surgery | Participating provider precertification list for Aetna, Pg 14 Original policy |
| 22216 | Spinal procedures (continued): Spinal fusion surgery | Participating provider precertification list for Aetna, Pg 14 Original policy |
| 22220 | Spinal procedures (continued): Spinal fusion surgery | Participating provider precertification list for Aetna, Pg 14 Original policy |
| 22222 | Spinal procedures (continued): Spinal fusion surgery | Participating provider precertification list for Aetna, Pg 14 Original policy |
Aetna precertification list
The participating-provider examples point at the official list. Open the list itself for the current file, including its effective date.
Plan and setting exceptions
Student Health and Allina Health / Aetna are separate from the participating-provider rows above.
Prior authorization forms
| Product or plan | Benefit | Route |
|---|---|---|
| Use the plan named on the official form page | Medical and pharmacy forms are listed by Aetna | Aetna health care professional forms |
This page does not reproduce a form and does not list a fax number that was not read from the form page.