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Aetna prior authorization and CPT code lookup, page 13

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

Prior authorization codes
CodeDescriptionSource
J7204Esperoct antihemophilic factor [recombinant], glycopegylated-exeiParticipating provider precertification list for Aetna, Pg 16 Original policy
J7191Factor XIII Factor viii (antihemophilic factor (porcine)Participating provider precertification list for Aetna, Pg 16 Original policy
J7198FEIBA, FEIBA NF anti-inhibitor coagulant complexParticipating provider precertification list for Aetna, Pg 17 Original policy
J7176Fesilty fibrinogen, human-chmt — precertification required effective July 1, 2026Participating provider precertification list for Aetna, Pg 17 Original policy
J7177Fibryga fibrinogen, humanParticipating provider precertification list for Aetna, Pg 17 Original policy
J1411Hemgenix etranacogene dezaparvovec — precertification required for the drug and site of careParticipating provider precertification list for Aetna, Pg 17 Original policy
J7170Hemlibra emicizumabParticipating provider precertification list for Aetna, Pg 17 Original policy
J7190Hemofil M antihemophilic factor [human]Participating provider precertification list for Aetna, Pg 17 Original policy
J7199Hemophilia clotting factor not otherwise classifiedParticipating provider precertification list for Aetna, Pg 17 Original policy
J7187Humate-P antihemophilic factor/von Willebrand factor complex [human]Participating provider precertification list for Aetna, Pg 17 Original policy
J7202Idelvion antihemophilic factor [recombinant]Participating provider precertification list for Aetna, Pg 17 Original policy
J7195Ixinity coagulation factor IX [recombinant]Participating provider precertification list for Aetna, Pg 17 Original policy
J7213Ixinity coagulation factor IX [recombinant]Participating provider precertification list for Aetna, Pg 17 Original policy
J7208Jivi antihemophilic factor [recombinant], PEGylated-auclParticipating provider precertification list for Aetna, Pg 17 Original policy
J7192Kogenate FS antihemophilic factor [recombinant]Participating provider precertification list for Aetna, Pg 17 Original policy
J7211Kovaltry antihemophilic factor [recombinant]Participating provider precertification list for Aetna, Pg 17 Original policy
J7182NovoEight antihemophilic factor [recombinant]Participating provider precertification list for Aetna, Pg 17 Original policy
J7189NovoSeven RT coagulation factor VIIa [recombinant]Participating provider precertification list for Aetna, Pg 17 Original policy
J7209Nuwiq simoctocog alfaParticipating provider precertification list for Aetna, Pg 18 Original policy
J7188Obizur antihemophilic factor [recombinant], porcine sequenceParticipating provider precertification list for Aetna, Pg 18 Original policy
J7194Profilnine factor IX complexParticipating provider precertification list for Aetna, Pg 18 Original policy
J7203Rebinyn coagulation factor IX [recombinant], glycoPEGylatedParticipating provider precertification list for Aetna, Pg 18 Original policy
J7192Recombinate antihemophilic factor [recombinant]Participating provider precertification list for Aetna, Pg 18 Original policy
J7178RiaSTAP fibrinogen concentrate [human]Participating provider precertification list for Aetna, Pg 18 Original policy
J7200Rixubis coagulation factor IX [recombinant]Participating provider precertification list for Aetna, Pg 18 Original policy
J1412Roctavian valoctocogene roxaparvovec-rvox — precertification required for the drug and site of careParticipating provider precertification list for Aetna, Pg 18 Original policy
J7212Sevenfact coagulation factor VIIa [recombinant]-jncwParticipating provider precertification list for Aetna, Pg 18 Original policy
J7181Tretten coagulation factor XIII a-subunit [recombinant]Participating provider precertification list for Aetna, Pg 18 Original policy
J7179Vonvendi von Willebrand factor [recombinant]Participating provider precertification list for Aetna, Pg 18 Original policy
J7183Wilate von Willebrand factor/coagulation factor VIII complex [human]Participating provider precertification list for Aetna, Pg 18 Original policy
J7185Xyntha, Xyntha Solofuse antihemophilic factor [recombinant]Participating provider precertification list for Aetna, Pg 18 Original policy
J9264Abraxane (paclitaxel protein-bound particles) — precertification required for Medicare Advantage members onlyParticipating provider precertification list for Aetna, Pg 19 Original policy
J0801Acthar Gel/H. P. Acthar (corticotropin)Participating provider precertification list for Aetna, Pg 19 Original policy
J0802Acthar Gel/H. P. Acthar (corticotropin)Participating provider precertification list for Aetna, Pg 19 Original policy
J0791Adakveo (crizanlizumab-tmca) — precertification required for the drug and site of careParticipating provider precertification list for Aetna, Pg 19 Original policy
J9042Adcetris (brentuximab vedotin) — precertification required for drug and site of careParticipating provider precertification list for Aetna, Pg 19 Original policy
J9029Adstiladrin (nadofaragene firadenovec-vncg)Participating provider precertification list for Aetna, Pg 19 Original policy
J0256Alpha 1-proteinase inhibitor (human) (precertification required for the drug and site of care): Aralast NP (alpha 1-proteinase inhibitor)Participating provider precertification list for Aetna, Pg 19 Original policy
J0257Alpha 1-proteinase inhibitor (human) (precertification required for the drug and site of care): Glassia (alpha 1-proteinase inhibitor)Participating provider precertification list for Aetna, Pg 19 Original policy
J0256Alpha 1-proteinase inhibitor (human) continued: Prolastin-C (alpha 1-proteinase inhibitor)Participating provider precertification list for Aetna, Pg 19 Original policy
J0256Alpha 1-proteinase inhibitor (human) continued: Zemaira (alpha 1-proteinase inhibitor)Participating provider precertification list for Aetna, Pg 19 Original policy
Q5126Alymsys (bevacizumab) — precertification required for the drug and site of care for oncology indications onlyParticipating provider precertification list for Aetna, Pg 19 Original policy
J0175Alzheimer’s disease (precertification required for the drug and site of care): Kisunla (donanemab-azbt)Participating provider precertification list for Aetna, Pg 19 Original policy
J0174Alzheimer’s disease (precertification required for the drug and site of care): Leqembi IV (lecanemab-irmb)Participating provider precertification list for Aetna, Pg 19 Original policy
J3490Alzheimer’s disease (precertification required for the drug and site of care): Leqembi SQ (lecanemab-irmb) — precertification required for MedicareParticipating provider precertification list for Aetna, Pg 19 Original policy
J3590Alzheimer’s disease (precertification required for the drug and site of care): Leqembi SQ (lecanemab-irmb) — precertification required for MedicareParticipating provider precertification list for Aetna, Pg 19 Original policy
C9399Alzheimer’s disease (precertification required for the drug and site of care): Leqembi SQ (lecanemab-irmb) — precertification required for MedicareParticipating provider precertification list for Aetna, Pg 19 Original policy
J3490Amtagvi (lifileucel,) — precertification required for the drug and site of care Contact National Medical ExcellenceParticipating provider precertification list for Aetna, Pg 20 Original policy
J3590Amtagvi (lifileucel,) — precertification required for the drug and site of care Contact National Medical ExcellenceParticipating provider precertification list for Aetna, Pg 20 Original policy
C9399Amtagvi (lifileucel,) — precertification required for the drug and site of care Contact National Medical ExcellenceParticipating provider precertification list for Aetna, Pg 20 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.

Aetna participating provider precertification list

Aetna precertification lists

Plan and setting exceptions

Student Health and Allina Health / Aetna are separate from the participating-provider rows above.

Prior authorization forms

Official Aetna form route
Product or planBenefitRoute
Use the plan named on the official form pageMedical and pharmacy forms are listed by AetnaAetna 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.

Sources

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.

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