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Aetna prior authorization and CPT code lookup, page 21

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
Q5161Osteoporosis drugs: Bosaya (denosumab-kyqq) — precertification required effective April 1, 2026Participating provider precertification list for Aetna, Pg 29 Original policy
Q5158Osteoporosis drugs: Conexxence (denosumab-bnht)Participating provider precertification list for Aetna, Pg 29 Original policy
J3490Osteoporosis drugs: denosumab-bnhtParticipating provider precertification list for Aetna, Pg 29 Original policy
J3590Osteoporosis drugs: denosumab-bnhtParticipating provider precertification list for Aetna, Pg 29 Original policy
C9399Osteoporosis drugs: denosumab-bnhtParticipating provider precertification list for Aetna, Pg 29 Original policy
J3490Osteoporosis drugs: denosumab-dssbParticipating provider precertification list for Aetna, Pg 29 Original policy
J3590Osteoporosis drugs: denosumab-dssbParticipating provider precertification list for Aetna, Pg 29 Original policy
C9399Osteoporosis drugs: denosumab-dssbParticipating provider precertification list for Aetna, Pg 29 Original policy
Q5167Osteoporosis drugs: Enoby (denosumab-qbde) — precertification required Effective April 1, 2026Participating provider precertification list for Aetna, Pg 29 Original policy
J3111Osteoporosis drugs: Evenity (romosozumab-aqqg) — precertification required for the drug and site ofParticipating provider precertification list for Aetna, Pg 29 Original policy
J3110Forteo (teriparatide) — precertification required for Medicare Advantage members onlyParticipating provider precertification list for Aetna, Pg 30 Original policy
Q5136Jubbonti (denosumab-bbdz)Participating provider precertification list for Aetna, Pg 30 Original policy
Q5166Jubereq (denosumab-desu) — precertification required effective April 1, 2026 — precertification required for site ofParticipating provider precertification list for Aetna, Pg 30 Original policy
J0630Miacalcin (calcitonin) — precertification required for Medicare Advantage members onlyParticipating provider precertification list for Aetna, Pg 30 Original policy
Q5157Osenvelt (denosumab-bmwo) — precertification required for the drug and site ofParticipating provider precertification list for Aetna, Pg 30 Original policy
Q5159Ospomyv (denosumab-dssb)Participating provider precertification list for Aetna, Pg 30 Original policy
Q5166Osvyrti (denosumab-desu) — precertification required effective April 1, 2026Participating provider precertification list for Aetna, Pg 30 Original policy
Q5165Oziltus (denosumab-mobz) — precertification required effective July 1, 2026Participating provider precertification list for Aetna, Pg 30 Original policy
Q5173Ponlimsi (denosumab-adet) — precertification required effective May 1, 2026Participating provider precertification list for Aetna, Pg 30 Original policy
J0897Prolia (denosumab)Participating provider precertification list for Aetna, Pg 30 Original policy
Q5157Stoboclo (denosumab-bmwo)Participating provider precertification list for Aetna, Pg 30 Original policy
J3110Teriparatide — precertification required forParticipating provider precertification list for Aetna, Pg 30 Original policy
Q5136Wyost (denosumab-bbdz) — precertification required for the drug and site ofParticipating provider precertification list for Aetna, Pg 30 Original policy
Q5159Xbryk (denosumab-dssb) — precertification required for the drug and site ofParticipating provider precertification list for Aetna, Pg 30 Original policy
J0897Xgeva (denosumab) — precertification required for the drug and site ofParticipating provider precertification list for Aetna, Pg 30 Original policy
Q5167Xtrenbo (denosumab-qbde) — precertification required effective April 1, 2026 — precertification required for site ofParticipating provider precertification list for Aetna, Pg 30 Original policy
J3490Otarmeni (lunsotogene parvec-cwah) — precertification required effective July 1, 2026Participating provider precertification list for Aetna, Pg 30 Original policy
J3590Otarmeni (lunsotogene parvec-cwah) — precertification required effective July 1, 2026Participating provider precertification list for Aetna, Pg 30 Original policy
C9399Otarmeni (lunsotogene parvec-cwah) — precertification required effective July 1, 2026Participating provider precertification list for Aetna, Pg 30 Original policy
J0224Oxlumo (lumasiran) — precertification required for the drug and site of careParticipating provider precertification list for Aetna, Pg 30 Original policy
J9264Paclitaxel protein-bound particles (American Regent) — precertification required for Medicare Advantage members onlyParticipating provider precertification list for Aetna, Pg 30 Original policy
J9177Padcev (enfortumab vedotin)Participating provider precertification list for Aetna, Pg 30 Original policy
Q5152drugs: (precertification required for the drug and site of care): Bkemv (eculizumab-aaeb)Participating provider precertification list for Aetna, Pg 30 Original policy
Q5151drugs: (precertification required for the drug and site of care): Epysqli (eculizumab-aagh)Participating provider precertification list for Aetna, Pg 30 Original policy
J1299drugs: (precertification required for the drug and site of care): Soliris (eculizumab)Participating provider precertification list for Aetna, Pg 30 Original policy
J1303drugs: (precertification required for the drug and site of care): Ultomiris (Ravulizumab-cwvz)Participating provider precertification list for Aetna, Pg 30 Original policy
J0606Parsabiv (etelcalcetide) — precertification required for Commercial members onlyParticipating provider precertification list for Aetna, Pg 30 Original policy
J3490(garetosmab-grts,)Participating provider precertification list for Aetna, Pg 30 Original policy
J3590(garetosmab-grts,)Participating provider precertification list for Aetna, Pg 30 Original policy
C9399(garetosmab-grts,)Participating provider precertification list for Aetna, Pg 30 Original policy
J9023PD1/PDL1 drugs (precertification required for the drug and site of care): Bavencio (avelumab)Participating provider precertification list for Aetna, Pg 30 Original policy
J9173PD1/PDL1 drugs (precertification required for the drug and site of care): Imfinzi (durvalumab)Participating provider precertification list for Aetna, Pg 30 Original policy
J9272PD1/PDL1 drugs (precertification required for the drug and site of care): Jemperli (dostarlimab-gxly)Participating provider precertification list for Aetna, Pg 30 Original policy
J9271PD1/PDL1 drugs (precertification required for the drug and site of care): Keytruda (pembrolizumab)Participating provider precertification list for Aetna, Pg 30 Original policy
J9277PD1/PDL1 drugs (precertification required for the drug and site of care): berahyaluronidase alfa-pmph)Participating provider precertification list for Aetna, Pg 30 Original policy
J9119Libtayo (cemiplimab-rwlc)Participating provider precertification list for Aetna, Pg 31 Original policy
J3263Loqtorzi (toripalimab-tpzi)Participating provider precertification list for Aetna, Pg 31 Original policy
J9299Opdivo (nivolumab)Participating provider precertification list for Aetna, Pg 31 Original policy
J9289nvhy)Participating provider precertification list for Aetna, Pg 31 Original policy
J9298Opdualag (nivolumab and relatlimab-rmbw)Participating provider precertification list for Aetna, Pg 31 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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