Talk to Us

Aetna prior authorization and CPT code lookup, page 19

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
S0128Injectable infertility drugs: Follistim AQ (follitropin beta)Participating provider precertification list for Aetna, Pg 27 Original policy
S0132Injectable infertility drugs: Ganirelix AC (ganirelix acetate)Participating provider precertification list for Aetna, Pg 27 Original policy
S0126Injectable infertility drugs: Gonal-f (follitropin alfa)Participating provider precertification list for Aetna, Pg 27 Original policy
S0126Injectable infertility drugs: Gonal-f RFF (follitropin alfa)Participating provider precertification list for Aetna, Pg 27 Original policy
S0122Injectable infertility drugs: Menopur (menotropins)Participating provider precertification list for Aetna, Pg 27 Original policy
J0725Injectable infertility drugs: Novarel (chorionic gonadotropin)Participating provider precertification list for Aetna, Pg 27 Original policy
J0725Injectable infertility drugs: Ovidrel (choriogonadotropin alfa)Participating provider precertification list for Aetna, Pg 27 Original policy
J0725Injectable infertility drugs: Pregnyl (chorionic gonadotropin)Participating provider precertification list for Aetna, Pg 27 Original policy
Q0138Iron replacement agents: Feraheme (ferumoxytol)Participating provider precertification list for Aetna, Pg 27 Original policy
Q0139Iron replacement agents: Feraheme (ferumoxytol)Participating provider precertification list for Aetna, Pg 27 Original policy
J1439Iron replacement agents: Injectafer (ferric carboxymaltose injection)Participating provider precertification list for Aetna, Pg 27 Original policy
J1437Iron replacement agents: Monoferric (ferric derisomaltose)Participating provider precertification list for Aetna, Pg 27 Original policy
J3405Itvisma (onasemnogene abeparvovec-brve) — precertification required for the drug and site of care effective April 1, 2026Participating provider precertification list for Aetna, Pg 27 Original policy
J9281Jelmyto (mitomycin) Jobevne (bevacizumab-nwgd)— precertification required for the drug and site of care effective October 1, 2026Participating provider precertification list for Aetna, Pg 27 Original policy
Q5160Jelmyto (mitomycin) Jobevne (bevacizumab-nwgd)— precertification required for the drug and site of care effective October 1, 2026Participating provider precertification list for Aetna, Pg 27 Original policy
J3490(eladocagene exuparvovec-tneq,Participating provider precertification list for Aetna, Pg 27 Original policy
J3590Kebilidi) — precertification required for the drug and site of careParticipating provider precertification list for Aetna, Pg 27 Original policy
C9399Kebilidi) — precertification required for the drug and site of careParticipating provider precertification list for Aetna, Pg 27 Original policy
J0642Khapzory (levoleucovorin)Participating provider precertification list for Aetna, Pg 27 Original policy
J9274Kimmtrak (tebentafusp-tebn)Participating provider precertification list for Aetna, Pg 27 Original policy
J0879Korsuva (difelikefalin) — precertification required for Commercial members onlyParticipating provider precertification list for Aetna, Pg 27 Original policy
J3490Kresladi (marnetegragene autotemcel)— precertification required for drug effective July 1, 2026 Contact National Medical ExcellenceParticipating provider precertification list for Aetna, Pg 27 Original policy
J3590Kresladi (marnetegragene autotemcel)— precertification required for drug effective July 1, 2026 Contact National Medical ExcellenceParticipating provider precertification list for Aetna, Pg 27 Original policy
C9399Kresladi (marnetegragene autotemcel)— precertification required for drug effective July 1, 2026 Contact National Medical ExcellenceParticipating provider precertification list for Aetna, Pg 27 Original policy
J2507Krystexxa (pegloticase) — precertification required for the drug and site of careParticipating provider precertification list for Aetna, Pg 27 Original policy
J9047Kyprolis (carfilzomib) Commercial plans — precertification required for multiple myeloma only Medicare plans — precertificatoin required for all diagnosesParticipating provider precertification list for Aetna, Pg 27 Original policy
J9278Kyxata (Carboplatin) — precertification required for Medicare only effective April 1, 2026Participating provider precertification list for Aetna, Pg 27 Original policy
J3490Lantidra (donislecel-jujn,) Contact National Medical ExcellenceParticipating provider precertification list for Aetna, Pg 27 Original policy
J3590Lantidra (donislecel-jujn,) Contact National Medical ExcellenceParticipating provider precertification list for Aetna, Pg 27 Original policy
C9399Lantidra (donislecel-jujn,) Contact National Medical ExcellenceParticipating provider precertification list for Aetna, Pg 27 Original policy
J3391Lenmeldy (atidarsagene autotemcel) — precertification required for the drug and site of care Contact National Medical ExcellenceParticipating provider precertification list for Aetna, Pg 27 Original policy
J9350Lunsumio (mosunetuzumab)Participating provider precertification list for Aetna, Pg 27 Original policy
J9350Lunsumio Velo (mosunetuzumab-axgb) — precertification required effective April 1, 2026Participating provider precertification list for Aetna, Pg 27 Original policy
J1952(LHRH) agents: Commercial plans — precertification required for prostate cancer only Medicare plans — precertification required for all diagnoses Camcevi (leuprolide mesylate)Participating provider precertification list for Aetna, Pg 28 Original policy
J9003(LHRH) agents: Commercial plans — precertification required for prostate cancer only Medicare plans — precertification required for all diagnoses Camcevi ETM (leuprolide mesylate) — precertification required effective July 1, 2026Participating provider precertification list for Aetna, Pg 28 Original policy
J9217(LHRH) agents: Commercial plans — precertification required for prostate cancer only Medicare plans — precertification required for all diagnoses Eligard (leuprolide acetate) — precertification required for CommercialParticipating provider precertification list for Aetna, Pg 28 Original policy
J9155(LHRH) agents: Commercial plans — precertification required for prostate cancer only Medicare plans — precertification required for all diagnoses Firmagon (degarelix) — precertification required for Commercial members onlyParticipating provider precertification list for Aetna, Pg 28 Original policy
J1950(LHRH) agents: Commercial plans — precertification required for prostate cancer only Medicare plans — precertification required for all diagnoses Lupron depot (leuprolide acetate) — precertification required for MedicareParticipating provider precertification list for Aetna, Pg 28 Original policy
J9217(LHRH) agents: Commercial plans — precertification required for prostate cancer only Medicare plans — precertification required for all diagnoses Lupron depot (leuprolide acetate)Participating provider precertification list for Aetna, Pg 28 Original policy
J1954(LHRH) agents: Commercial plans — precertification required for prostate cancer only Medicare plans — precertification required for all diagnoses Lutrate (leuprolide acetate)Participating provider precertification list for Aetna, Pg 28 Original policy
J3315(LHRH) agents: Commercial plans — precertification required for prostate cancer only Medicare plans — precertification required for all diagnoses Trelstar (triptorelin pamoate)Participating provider precertification list for Aetna, Pg 28 Original policy
J9217(LHRH) agents: Commercial plans — precertification required for prostate cancer only Medicare plans — precertification required for all diagnoses Vabrinty (leuprolide acetate) — precertification required for CommercialParticipating provider precertification list for Aetna, Pg 28 Original policy
J9202(LHRH) agents: Commercial plans — precertification required for prostate cancer only Medicare plans — precertification required for all diagnoses Zoladex (goserelin)Participating provider precertification list for Aetna, Pg 28 Original policy
J3394Lyfgenia (lovotibeglogene autotemcel) — precertification required for the drug and site of care Contact National Medical ExcellenceParticipating provider precertification list for Aetna, Pg 28 Original policy
J9161Lymphir (denileukin diftitox-cxdl) Lynozyfic IV (Linvoseltamab – gcpt)Participating provider precertification list for Aetna, Pg 28 Original policy
J9601Lymphir (denileukin diftitox-cxdl) Lynozyfic IV (Linvoseltamab – gcpt)Participating provider precertification list for Aetna, Pg 28 Original policy
J9349Monjuvi (tafasitamab-cxix)Participating provider precertification list for Aetna, Pg 28 Original policy
J2329Multiple sclerosis drugs (precertification required for the drug and site of care): Briumvi (ublituximab)Participating provider precertification list for Aetna, Pg 28 Original policy
J0202Multiple sclerosis drugs (precertification required for the drug and site of care): Lemtrada (alemtuzumab)Participating provider precertification list for Aetna, Pg 28 Original policy
J2350Multiple sclerosis drugs (precertification required for the drug and site of care): Ocrevus (ocrelizumab)Participating provider precertification list for Aetna, Pg 28 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.

This website uses cookies to ensure you get the best experience on our website. Learn more