Aetna prior authorization and CPT code lookup, page 14
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 |
|---|---|---|
| J9999 | Amtagvi (lifileucel,) — precertification required for the drug and site of care Contact National Medical Excellence | Participating provider precertification list for Aetna, Pg 20 Original policy |
| J1304 | Amyotrophic lateral sclerosis (ALS) drugs: (precertification required for the drug and site of care): Qalsody (tofersen) | Participating provider precertification list for Aetna, Pg 20 Original policy |
| J1301 | Amyotrophic lateral sclerosis (ALS) drugs: (precertification required for the drug and site of care): Radicava (edaravone) | Participating provider precertification list for Aetna, Pg 20 Original policy |
| J9028 | Anktiva (nogapendekin alfa inbakicept-pmln) | Participating provider precertification list for Aetna, Pg 20 Original policy |
| Q5121 | Autoimmune infused infliximab: (precertification required for the drug and site of care): Avsola (infliximab-axxq) | Participating provider precertification list for Aetna, Pg 20 Original policy |
| Q5103 | Autoimmune infused infliximab: (precertification required for the drug and site of care): Inflectra (infliximab-dyyb) | Participating provider precertification list for Aetna, Pg 20 Original policy |
| J1745 | Autoimmune infused infliximab: (precertification required for the drug and site of care): Remicade (infliximab) | Participating provider precertification list for Aetna, Pg 20 Original policy |
| Q5104 | Autoimmune infused infliximab: (precertification required for the drug and site of care): Renflexis (infliximab-abda) | Participating provider precertification list for Aetna, Pg 20 Original policy |
| J9035 | Avastin (bevacizumab) — precertification required for the drug and site of care for oncology indications only | Participating provider precertification list for Aetna, Pg 20 Original policy |
| J3145 | Aveed (testosterone undecanoate) | Participating provider precertification list for Aetna, Pg 20 Original policy |
| J9292 | Axtle (pemetrexed, avyxa) — precertification required for Medicare Advantage members precertification required for commercial members effective July 1, 2026 | Participating provider precertification list for Aetna, Pg 20 Original policy |
| J3490 | Avzivi (bevacizumab-tnjn,)— precertification required for the drug and site of care effective October 1, 2026 | Participating provider precertification list for Aetna, Pg 20 Original policy |
| J3590 | Avzivi (bevacizumab-tnjn,)— precertification required for the drug and site of care effective October 1, 2026 | Participating provider precertification list for Aetna, Pg 20 Original policy |
| C9399 | Avzivi (bevacizumab-tnjn,)— precertification required for the drug and site of care effective October 1, 2026 | Participating provider precertification list for Aetna, Pg 20 Original policy |
| J9999 | Avzivi (bevacizumab-tnjn,)— precertification required for the drug and site of care effective October 1, 2026 | Participating provider precertification list for Aetna, Pg 20 Original policy |
| J9174 | Beizray (docetaxel) precertification required for Medicare Advantage members precertification required for commercial members effective July 1, 2026 | Participating provider precertification list for Aetna, Pg 20 Original policy |
| J9036 | Belrapzo (bendamustine HCl) | Participating provider precertification list for Aetna, Pg 20 Original policy |
| J9034 | Bendeka (bendamustine HCl) | Participating provider precertification list for Aetna, Pg 20 Original policy |
| J0490 | Benlysta (belimumab) — precertification required for the drug and site of care | Participating provider precertification list for Aetna, Pg 20 Original policy |
| J9229 | Besponsa (inotuzumab ozogamicin) | Participating provider precertification list for Aetna, Pg 20 Original policy |
| J9382 | Bizengri (zenocutuzumab-zbco) | Participating provider precertification list for Aetna, Pg 20 Original policy |
| J9053 | Blenrep (belantamab mafodotin) | Participating provider precertification list for Aetna, Pg 20 Original policy |
| J9051 | Bortezomib (maia) Commercial plans — precertification required for multiple myeloma only Medicare plans — precertification required for all diagnoses | Participating provider precertification list for Aetna, Pg 20 Original policy |
| J9048 | Bortezomib (fresenius kabi) Commercial plans only effective October 1, 2026— precertification required for multiple myeloma only | Participating provider precertification list for Aetna, Pg 20 Original policy |
| J9054 | Boruzu (bortezomib) Commercial plans — precertification required for multiple myeloma only Medicare plans — precertification required for all diagnoses | Participating provider precertification list for Aetna, Pg 20 Original policy |
| J0585 | Botulinum toxins: Botox (onabotulinumtoxinA) — precertification required for Commercial | Participating provider precertification list for Aetna, Pg 21 Original policy |
| J0589 | Botulinum toxins: Daxxify (daxibotulinumtoxin A) | Participating provider precertification list for Aetna, Pg 21 Original policy |
| J0586 | Botulinum toxins: Dysport (abobotulinumtoxinA) | Participating provider precertification list for Aetna, Pg 21 Original policy |
| J3490 | Botulinum toxins: Letybo (letibotulinumtoxinA-wlbg,) | Participating provider precertification list for Aetna, Pg 21 Original policy |
| J3590 | Botulinum toxins: Letybo (letibotulinumtoxinA-wlbg,) | Participating provider precertification list for Aetna, Pg 21 Original policy |
| C9399 | Botulinum toxins: Letybo (letibotulinumtoxinA-wlbg,) | Participating provider precertification list for Aetna, Pg 21 Original policy |
| J0587 | Botulinum toxins: Myobloc (rimabotulinumtoxinB) | Participating provider precertification list for Aetna, Pg 21 Original policy |
| J0588 | Botulinum toxins: Xeomin (incobotulinumtoxinA) — precertification required for Commercial | Participating provider precertification list for Aetna, Pg 21 Original policy |
| J0741 | Cabenuva (cabotegravir; rilpivirine) — precertification required for drug and site of care effective April 1, 2026 for commercial members only | Participating provider precertification list for Aetna, Pg 21 Original policy |
| C9047 | Cablivi (caplacizumab-yhdp) | Participating provider precertification list for Aetna, Pg 21 Original policy |
| J3032 | receptor inhibitors: Vyepti (eptinezumab-jjmr) — precertification required for the drug and site of | Participating provider precertification list for Aetna, Pg 21 Original policy |
| J1306 | Cardiovascular — PCSK9 inhibitors: Leqvio (inclisiran) | Participating provider precertification list for Aetna, Pg 21 Original policy |
| J3392 | Casgevy (exagamglogene autotemcel) — precertification required for the drug and site of care Contact National Medical Excellence | Participating provider precertification list for Aetna, Pg 21 Original policy |
| Q2055 | (continued): Abecma (idecabtagene vicleucel) | Participating provider precertification list for Aetna, Pg 21 Original policy |
| Q2058 | (continued): Aucatzyl (obecabtagene autoleucel, obe-cel) | Participating provider precertification list for Aetna, Pg 21 Original policy |
| Q2054 | (continued): Breyanzi (lisocabtagene maraleucel) | Participating provider precertification list for Aetna, Pg 21 Original policy |
| Q2056 | (continued): Carvykti (ciltacabtagene autoleucel) | Participating provider precertification list for Aetna, Pg 21 Original policy |
| Q2042 | (continued): Kymriah (tisagenlecleucel) | Participating provider precertification list for Aetna, Pg 21 Original policy |
| Q2053 | (continued): Tecartus (brexucabtagene autoleucel) | Participating provider precertification list for Aetna, Pg 21 Original policy |
| Q2041 | (continued): Yescarta (axicabtagene ciloleucel) | Participating provider precertification list for Aetna, Pg 21 Original policy |
| J9286 | Columvi (glofitamab-gxbm) | Participating provider precertification list for Aetna, Pg 21 Original policy |
| J1307 | Complement inhibitor drugs: (precertification required for the drug and site of care): Piasky (crovalimab-akkz) | Participating provider precertification list for Aetna, Pg 21 Original policy |
| J9376 | Complement inhibitor drugs: (precertification required for the drug and site of care): Veopoz (pozelimab-bbfg) | Participating provider precertification list for Aetna, Pg 21 Original policy |
| J3490 | Cortrophin Gel (repository corticotropin) | Participating provider precertification list for Aetna, Pg 21 Original policy |
| J3590 | Cortrophin Gel (repository corticotropin) | Participating provider precertification list for Aetna, Pg 21 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.