Aetna prior authorization and CPT code lookup, page 16

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
C9312Evdi (trabectedin) — precertification required effective August 1, 2026Participating provider precertification list for Aetna, Pg 23 Original policy
J1305Evkeeza (evinacumab-dgnb) — precertification required for the drug and site of careParticipating provider precertification list for Aetna, Pg 23 Original policy
J2916Ferrlecit (sodium ferric gluconate) — precertification required for Commercial members only August 1, 2026Participating provider precertification list for Aetna, Pg 23 Original policy
J9331Fyarro (sirolimus protein-bound particles for injectable suspension)Participating provider precertification list for Aetna, Pg 23 Original policy
J3490Gattex (teduglutidem)Participating provider precertification list for Aetna, Pg 23 Original policy
J9210Gamifant (emapalumab-lzsg) — precertification required effective October 1, 2026Participating provider precertification list for Aetna, Pg 23 Original policy
J0223Givlaari (givosiran) — precertification required for the drug and site of careParticipating provider precertification list for Aetna, Pg 23 Original policy
J3490Genglycos (pariglasgene brecaparvovec)— precertification required for drug effective October 1, 2026Participating provider precertification list for Aetna, Pg 23 Original policy
J3590Genglycos (pariglasgene brecaparvovec)— precertification required for drug effective October 1, 2026Participating provider precertification list for Aetna, Pg 23 Original policy
C9399Genglycos (pariglasgene brecaparvovec)— precertification required for drug effective October 1, 2026Participating provider precertification list for Aetna, Pg 23 Original policy
Q5169Granulocyte-colony stimulating factors: Armlupeg (pegfilgrastim-unne) — precertification required effective April 1, 2026Participating provider precertification list for Aetna, Pg 23 Original policy
J3490Granulocyte-colony stimulating factors: Ennumo (pegfilgrastim-pccg,) — precertification required effectiveParticipating provider precertification list for Aetna, Pg 23 Original policy
J3590Granulocyte-colony stimulating factors: Ennumo (pegfilgrastim-pccg,) — precertification required effectiveParticipating provider precertification list for Aetna, Pg 23 Original policy
C9399Granulocyte-colony stimulating factors: Ennumo (pegfilgrastim-pccg,) — precertification required effectiveParticipating provider precertification list for Aetna, Pg 23 Original policy
Q5172Granulocyte-colony stimulating factors: Filkri (filgrastim-laha) — precertification required effective May 1, 2026Participating provider precertification list for Aetna, Pg 23 Original policy
Q5108Granulocyte-colony stimulating factors: Fulphila (pegfilgrastim-jmdb) — precertification required for commercial onlyParticipating provider precertification list for Aetna, Pg 23 Original policy
Q5130Granulocyte-colony stimulating factors: Fylnetra (pegfilgrastim-pbbk)Participating provider precertification list for Aetna, Pg 23 Original policy
J1447Granulocyte-colony stimulating factors: Granix (tbo-filgrastim)Participating provider precertification list for Aetna, Pg 23 Original policy
J2820Granulocyte-colony stimulating factors: Leukine (sargramostim)Participating provider precertification list for Aetna, Pg 23 Original policy
J2506Granulocyte-colony stimulating factors: Neulasta (pegfilgrastim) — precertification required for Commercial members onlyParticipating provider precertification list for Aetna, Pg 23 Original policy
J1442Granulocyte-colony stimulating factors: Neupogen (filgrastim)Participating provider precertification list for Aetna, Pg 23 Original policy
Q5110Granulocyte-colony stimulating factors: Nivestym (filgrastim-aafi)Participating provider precertification list for Aetna, Pg 23 Original policy
Q5148Granulocyte-colony stimulating factors: Nypozi (filgrastim-txid)Participating provider precertification list for Aetna, Pg 23 Original policy
Q5122Granulocyte-colony stimulating factors: Nyvepria (pegfilgrastim-apgf)Participating provider precertification list for Aetna, Pg 23 Original policy
Q5125Granulocyte-colony stimulating factors: Releuko (filgrastim-ayow)Participating provider precertification list for Aetna, Pg 23 Original policy
J1449Granulocyte-colony stimulating factors: Rolvedon (eflapegrastim-xnst)Participating provider precertification list for Aetna, Pg 23 Original policy
J9361Granulocyte-colony stimulating factors: Ryzneuta (efbemalenograstim alfa-vuxw)Participating provider precertification list for Aetna, Pg 23 Original policy
Q5127Stimufend (pegfilgrastim-fpgk)Participating provider precertification list for Aetna, Pg 24 Original policy
Q5111Udenyca (pegfilgrastim-cbvq)Participating provider precertification list for Aetna, Pg 24 Original policy
Q5111Udenyca OBI (pegfilgrastim-cbqv)Participating provider precertification list for Aetna, Pg 24 Original policy
Q5120Ziextenzo (pegfilgrastim-bmez)Participating provider precertification list for Aetna, Pg 24 Original policy
J3490Growth hormone: Skytrofa (lonapegsomatropin-tcgd) — precertification required for MedicareParticipating provider precertification list for Aetna, Pg 24 Original policy
J3590Growth hormone: Skytrofa (lonapegsomatropin-tcgd) — precertification required for MedicareParticipating provider precertification list for Aetna, Pg 24 Original policy
J0597Hereditary angioedema agents: Berinert (C1 esterase inhibitor)Participating provider precertification list for Aetna, Pg 24 Original policy
J0598Hereditary angioedema agents: Cinryze (C1 esterase inhibitor) — precertification required for the drug and site ofParticipating provider precertification list for Aetna, Pg 24 Original policy
J3490Hereditary angioedema agents: Dawnzera (Donidalorsen Sodium)Participating provider precertification list for Aetna, Pg 24 Original policy
J3590Hereditary angioedema agents: Dawnzera (Donidalorsen Sodium)Participating provider precertification list for Aetna, Pg 24 Original policy
C9399Hereditary angioedema agents: Dawnzera (Donidalorsen Sodium)Participating provider precertification list for Aetna, Pg 24 Original policy
J1744Hereditary angioedema agents: Firazyr SC (icatibant acetate) — precertification required for CommercialParticipating provider precertification list for Aetna, Pg 24 Original policy
J0599Hereditary angioedema agents: [human]) — precertification required forParticipating provider precertification list for Aetna, Pg 24 Original policy
J1290Hereditary angioedema agents: Kalbitor (ecallantide)Participating provider precertification list for Aetna, Pg 24 Original policy
J0596Hereditary angioedema agents: Ruconest (C1 esterase inhibitor)Participating provider precertification list for Aetna, Pg 24 Original policy
J1744Hereditary angioedema agents: Sajazir SC (icatibant acetate) — precertification required for CommercialParticipating provider precertification list for Aetna, Pg 24 Original policy
J0593Hereditary angioedema agents: Takhzyro (lanadelumab-flyo)Participating provider precertification list for Aetna, Pg 24 Original policy
J0225(ATTR) drugs: Amvuttra (vutrisiran) — precertification required for the drug and site of careParticipating provider precertification list for Aetna, Pg 24 Original policy
J0222(ATTR) drugs continued: Onpattro (patisiran) — precertification required for the drug and site of careParticipating provider precertification list for Aetna, Pg 24 Original policy
C9311(ATTR) drugs continued: Wainua (eplontersen)Participating provider precertification list for Aetna, Pg 24 Original policy
J9358HER2 receptor drugs: deruxtecan-nxki)Participating provider precertification list for Aetna, Pg 24 Original policy
J9355HER2 receptor drugs: Herceptin (trastuzumab) — precertification required for the drug and site of careParticipating provider precertification list for Aetna, Pg 24 Original policy
J9356HER2 receptor drugs: hyaluronidase-oysk)Participating provider precertification list for Aetna, Pg 24 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.