Aetna prior authorization and CPT code lookup, page 15
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 |
|---|---|---|
| J1448 | Cosela (Trilaciclib, | Participating provider precertification list for Aetna, Pg 21 Original policy |
| J0584 | Crysvita (burosumab-twza) — precertification required for the drug and site of care | Participating provider precertification list for Aetna, Pg 21 Original policy |
| J9308 | Cyramza (ramucirumab) | Participating provider precertification list for Aetna, Pg 21 Original policy |
| J9348 | Danyelza (naxitamab-gqgk) | Participating provider precertification list for Aetna, Pg 21 Original policy |
| J9145 | Darzalex (daratumumab) | Participating provider precertification list for Aetna, Pg 21 Original policy |
| J9144 | Darzalex Faspro (daratumumab and hyaluronidase-fihj) — precertification required for the drug and site of care effective October 1, 2026 | Participating provider precertification list for Aetna, Pg 21 Original policy |
| J9011 | Datroway (datopotamab deruxtecan-dlnk)— precertification required for the drug only effective October 1, 2026 | Participating provider precertification list for Aetna, Pg 22 Original policy |
| C9313 | Decnupaz (Pivekimab Sunirine-pvzy)— precertification required effective August 1, 2026 | Participating provider precertification list for Aetna, Pg 22 Original policy |
| J9172 | Docivyx (docetaxel)- precertification required for Medicare Advantage members precertification required for commercial members effective July 1, 2026 | Participating provider precertification list for Aetna, Pg 22 Original policy |
| J9063 | Elahere (mirvetuximab soravtansine-gynx) | Participating provider precertification list for Aetna, Pg 22 Original policy |
| J1323 | Elrexfio (elranatamab-bcmm) | Participating provider precertification list for Aetna, Pg 22 Original policy |
| J9269 | Elzonris (Tagraxofusp)— precertification required effective October 1, 2026 | Participating provider precertification list for Aetna, Pg 22 Original policy |
| J9176 | Empliciti (elotuzumab) Emrelis (telisotuzumab vedotin-tllv) | Participating provider precertification list for Aetna, Pg 22 Original policy |
| J9326 | Empliciti (elotuzumab) Emrelis (telisotuzumab vedotin-tllv) | Participating provider precertification list for Aetna, Pg 22 Original policy |
| J1302 | Enjaymo (Sutimlimab-jome) — precertification required for the drug and site of care | Participating provider precertification list for Aetna, Pg 22 Original policy |
| J7171 | Enzyme replacement drugs: Adzynma (ADAMTS13, recombinant-krhn) — precertification required for the drug and site | Participating provider precertification list for Aetna, Pg 22 Original policy |
| J1931 | Enzyme replacement drugs: Aldurazyme (laronidase) — precertification required for the drug and site of care | Participating provider precertification list for Aetna, Pg 22 Original policy |
| J1757 | Enzyme replacement drugs: Avlayah (tividenofusp alfa-eknm)— precertification required effective May 1, 2026 | Participating provider precertification list for Aetna, Pg 22 Original policy |
| J0567 | Enzyme replacement drugs: Brineura (cerliponase alfa) | Participating provider precertification list for Aetna, Pg 22 Original policy |
| J1786 | Enzyme replacement drugs (continued): Cerezyme (imiglucerase) — precertification required for the drug and site of care | Participating provider precertification list for Aetna, Pg 22 Original policy |
| J1743 | Enzyme replacement drugs (continued): Elaprase (idursulfase) — precertification required for the drug and site of care | Participating provider precertification list for Aetna, Pg 22 Original policy |
| J3060 | Enzyme replacement drugs (continued): Elelyso (taliglucerase alfa) — precertification required for the drug and site of | Participating provider precertification list for Aetna, Pg 22 Original policy |
| J2508 | Enzyme replacement drugs (continued): Elfabrio (pegunigalsidase alfa-iwxj) — precertification required for the drug and site of | Participating provider precertification list for Aetna, Pg 22 Original policy |
| J0180 | Enzyme replacement drugs (continued): Fabrazyme (agalsidase beta) — precertification required for the drug and site of | Participating provider precertification list for Aetna, Pg 22 Original policy |
| J2840 | Enzyme replacement drugs (continued): Kanuma (sebelipase alfa) — precertification required for the drug and site of | Participating provider precertification list for Aetna, Pg 22 Original policy |
| J0217 | Enzyme replacement drugs (continued): Lamzede (velmanase alfa) | Participating provider precertification list for Aetna, Pg 22 Original policy |
| J1818 | Enzyme replacement drugs (continued): Loargys (pegzilarginase - nbln) — precertification required for the drug and site of | Participating provider precertification list for Aetna, Pg 22 Original policy |
| J0220 | Enzyme replacement drugs (continued): Lumizyme (alglucosidase alfa) — precertification required for the drug and site of | Participating provider precertification list for Aetna, Pg 22 Original policy |
| J0221 | Enzyme replacement drugs (continued): Lumizyme (alglucosidase alfa) — precertification required for the drug and site of | Participating provider precertification list for Aetna, Pg 22 Original policy |
| J3397 | Enzyme replacement drugs (continued): Mepsevii (vestronidase alfa-vjbk) — precertification required for the drug and site of | Participating provider precertification list for Aetna, Pg 22 Original policy |
| J1458 | Enzyme replacement drugs (continued): Naglazyme (galsulfase) — precertification required for the drug and site of care | Participating provider precertification list for Aetna, Pg 22 Original policy |
| J0219 | Enzyme replacement drugs (continued): Nexviazyme (avalglucosidase alfa-ngpt) — precertification required for the drug and site of | Participating provider precertification list for Aetna, Pg 22 Original policy |
| J1203 | Enzyme replacement drugs (continued): Pombiliti (cipaglucosidase alfa-atga) | Participating provider precertification list for Aetna, Pg 22 Original policy |
| J3490 | Enzyme replacement drugs (continued): Strensiq (asfotase alfa) | Participating provider precertification list for Aetna, Pg 22 Original policy |
| J3590 | Enzyme replacement drugs (continued): Strensiq (asfotase alfa) | Participating provider precertification list for Aetna, Pg 22 Original policy |
| J1322 | Enzyme replacement drugs (continued): Vimizim (elosulfase alfa) — precertification required for the drug and site of care | Participating provider precertification list for Aetna, Pg 22 Original policy |
| J3385 | VPRIV (velaglucerase alfa) — precertification required for the drug and site of | Participating provider precertification list for Aetna, Pg 23 Original policy |
| J0218 | Xenpozyme (olipudase alfa-rpcp) — precertification required for the drug and site of | Participating provider precertification list for Aetna, Pg 23 Original policy |
| J9321 | Epkinly (epcoritamab-bysp) | Participating provider precertification list for Aetna, Pg 23 Original policy |
| J9055 | Erbitux (cetuximab) | Participating provider precertification list for Aetna, Pg 23 Original policy |
| J0881 | Erythropoiesis-stimulating agents: Aranesp (darbepoetin alfa) — precertification required for Commercial | Participating provider precertification list for Aetna, Pg 23 Original policy |
| J0882 | Erythropoiesis-stimulating agents: Aranesp (darbepoetin alfa) — precertification required for Commercial | Participating provider precertification list for Aetna, Pg 23 Original policy |
| J0885 | Erythropoiesis-stimulating agents: Epogen (epoetin alfa) | Participating provider precertification list for Aetna, Pg 23 Original policy |
| Q4081 | Erythropoiesis-stimulating agents: Epogen (epoetin alfa) | Participating provider precertification list for Aetna, Pg 23 Original policy |
| J0887 | Erythropoiesis-stimulating agents: beta) — precertification required | Participating provider precertification list for Aetna, Pg 23 Original policy |
| J0888 | Erythropoiesis-stimulating agents: beta) — precertification required | Participating provider precertification list for Aetna, Pg 23 Original policy |
| J0885 | Erythropoiesis-stimulating agents: Procrit (epoetin alfa) — precertification required for Commercial | Participating provider precertification list for Aetna, Pg 23 Original policy |
| Q4081 | Erythropoiesis-stimulating agents: Procrit (epoetin alfa) — precertification required for Commercial | Participating provider precertification list for Aetna, Pg 23 Original policy |
| Q5105 | Erythropoiesis-stimulating agents: erythropoietin-epbx) | Participating provider precertification list for Aetna, Pg 23 Original policy |
| Q5106 | Erythropoiesis-stimulating agents: erythropoietin-epbx) | Participating provider precertification list for Aetna, Pg 23 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.