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Aetna prior authorization and CPT code lookup, page 18

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
J9256Imaavy (nipocalimab-aahu) — precertification required for the drug and site ofParticipating provider precertification list for Aetna, Pg 26 Original policy
J3490Immgolis Intri (golimumab-sldi,) — precertification required for the drugParticipating provider precertification list for Aetna, Pg 26 Original policy
J3590Immgolis Intri (golimumab-sldi,) — precertification required for the drugParticipating provider precertification list for Aetna, Pg 26 Original policy
C9399Immgolis Intri (golimumab-sldi,) — precertification required for the drugParticipating provider precertification list for Aetna, Pg 26 Original policy
Q5098Imuldosa (ustekinumab-srlf)Participating provider precertification list for Aetna, Pg 26 Original policy
J2267Omvoh (mirikizumab-mrkz)Participating provider precertification list for Aetna, Pg 26 Original policy
J0129Orencia SQ (abatacept) — precertification required for Medicare Advantage members onlyParticipating provider precertification list for Aetna, Pg 26 Original policy
J0129Orencia IV (abatacept) — precertification required for the drug and site of careParticipating provider precertification list for Aetna, Pg 26 Original policy
Q9999Otulfi SQ/IV (ustekinumab-aauz)Participating provider precertification list for Aetna, Pg 26 Original policy
J3404Papzimeos (zopapogene imadenovec-drba) — precertification required for the drugParticipating provider precertification list for Aetna, Pg 26 Original policy
Q9997Pyzchiva IV (ustekinumab-ttwe)Participating provider precertification list for Aetna, Pg 26 Original policy
Q9996Pyzchiva SC (ustekinumab-ttwe) — precertification required for commercialParticipating provider precertification list for Aetna, Pg 26 Original policy
Q5123Riabni (rituximab-arrx) — precertification required for the drug and site of careParticipating provider precertification list for Aetna, Pg 26 Original policy
J9312Rituxan (rituximab) — precertification required for the drug and site of careParticipating provider precertification list for Aetna, Pg 26 Original policy
J9311human)Participating provider precertification list for Aetna, Pg 26 Original policy
Q5119Ruxience (rituximab-pvvr) — precertification required for the drug and site ofParticipating provider precertification list for Aetna, Pg 26 Original policy
J9333Rystiggo (rozanolixizumab-noli)Participating provider precertification list for Aetna, Pg 26 Original policy
Q9998Selarsdi (ustekinumab-aekn)Participating provider precertification list for Aetna, Pg 26 Original policy
J1602Simponi Aria (golimumab) — precertification required for the drug and site ofParticipating provider precertification list for Aetna, Pg 26 Original policy
J2327Skyrizi IV (risankizumab-rzaa)Participating provider precertification list for Aetna, Pg 26 Original policy
J1747Spevigo (spesolimab-sbzo) — precertification required for drug and site ofParticipating provider precertification list for Aetna, Pg 26 Original policy
Q5164Immunnologics agents (continued): Starjemza (ustekinumab-hmny)Participating provider precertification list for Aetna, Pg 26 Original policy
J3357Immunnologics agents (continued): Stelara SC*(ustekinumab) — precertification required for CommercialParticipating provider precertification list for Aetna, Pg 26 Original policy
J3358Immunnologics agents (continued): Stelara IV (ustekinumab)Participating provider precertification list for Aetna, Pg 26 Original policy
Q5099Immunnologics agents (continued): Steqeyma (ustekinumab-stba)Participating provider precertification list for Aetna, Pg 26 Original policy
Q5133Immunnologics agents (continued): Tofidence (tocilizumab-bavi)Participating provider precertification list for Aetna, Pg 26 Original policy
J1628Immunnologics agents (continued): Tremfya IV (guselkumab)Participating provider precertification list for Aetna, Pg 26 Original policy
Q5115Immunnologics agents (continued): Truxima (rituximab-abbs) — precertification required for the drug and site of careParticipating provider precertification list for Aetna, Pg 26 Original policy
Q5135Immunnologics agents (continued): Tyenne (tocilizumab-aazg,) —precertification required for drug andParticipating provider precertification list for Aetna, Pg 26 Original policy
J3490Immunnologics agents (continued): Tyenne (tocilizumab-aazg,) —precertification required for drug andParticipating provider precertification list for Aetna, Pg 26 Original policy
J3590Immunnologics agents (continued): Tyenne (tocilizumab-aazg,) —precertification required for drug andParticipating provider precertification list for Aetna, Pg 26 Original policy
C9399Immunnologics agents (continued): Tyenne (tocilizumab-aazg,) —precertification required for drug andParticipating provider precertification list for Aetna, Pg 26 Original policy
J3358Immunnologics agents (continued): ustekinumabParticipating provider precertification list for Aetna, Pg 26 Original policy
Q9999Immunnologics agents (continued): ustekinumab-aauzParticipating provider precertification list for Aetna, Pg 26 Original policy
Q9998Immunnologics agents (continued): ustekinumab-aeknParticipating provider precertification list for Aetna, Pg 26 Original policy
Q5009Immunnologics agents (continued): ustekinumab-stbaParticipating provider precertification list for Aetna, Pg 26 Original policy
Q9997Immunnologics agents (continued): ustekinumab-ttweParticipating provider precertification list for Aetna, Pg 26 Original policy
J9332Immunnologics agents (continued): Vyvgart (efgartigimod alfa-fcab)Participating provider precertification list for Aetna, Pg 26 Original policy
J9334Immunnologics agents (continued): hyaluronidase-qvfc) — precertification required for the drug and site of care. Site ofParticipating provider precertification list for Aetna, Pg 26 Original policy
Q5138Immunnologics agents (continued): Wezlana IV (ustekinumab-auub)Participating provider precertification list for Aetna, Pg 26 Original policy
Q5137Immunnologics agents (continued): Wezlana SC (ustekinumab-auub)Participating provider precertification list for Aetna, Pg 26 Original policy
Q5100Immunnologics agents (continued): Yesintek (ustekinumab-kfce)Participating provider precertification list for Aetna, Pg 26 Original policy
J3490Immunnologics agents (continued): Zimrixby (rituximab-cdxx,) — precertification required for drug andParticipating provider precertification list for Aetna, Pg 26 Original policy
J3590Immunnologics agents (continued): Zimrixby (rituximab-cdxx,) — precertification required for drug andParticipating provider precertification list for Aetna, Pg 26 Original policy
C9399Immunnologics agents (continued): Zimrixby (rituximab-cdxx,) — precertification required for drug andParticipating provider precertification list for Aetna, Pg 26 Original policy
J9999Immunnologics agents (continued): Zimrixby (rituximab-cdxx,) — precertification required for drug andParticipating provider precertification list for Aetna, Pg 26 Original policy
J9183Immunnologics agents (continued): site of care effective October 1, 2026 Inlexzo (gemcitabine intravesical system) — precertification required effective July 1, 2026Participating provider precertification list for Aetna, Pg 26 Original policy
J0725Injectable infertility drugs: Chorionic gonadotropinParticipating provider precertification list for Aetna, Pg 27 Original policy
J3490Injectable infertility drugs: Cetrotide (cetrorelix acetate)Participating provider precertification list for Aetna, Pg 27 Original policy
J3590Injectable infertility drugs: Cetrotide (cetrorelix acetate)Participating provider precertification list for Aetna, Pg 27 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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