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Aetna prior authorization and CPT code lookup, page 23

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
J3590Saphnelo SC (Anifrolumab-fnia) — precertification required for the drug and site of care effective July 1, 2026.Participating provider precertification list for Aetna, Pg 32 Original policy
C9399Saphnelo SC (Anifrolumab-fnia) — precertification required for the drug and site of care effective July 1, 2026.Participating provider precertification list for Aetna, Pg 32 Original policy
J9227Sarclisa (isatuximab-irfc)Participating provider precertification list for Aetna, Pg 32 Original policy
J3490Sarclisa Escena SC (isatuximab-irfc) — precertification required effective September 1, 2026Participating provider precertification list for Aetna, Pg 32 Original policy
J3590Sarclisa Escena SC (isatuximab-irfc) — precertification required effective September 1, 2026Participating provider precertification list for Aetna, Pg 32 Original policy
J9999Sarclisa Escena SC (isatuximab-irfc) — precertification required effective September 1, 2026Participating provider precertification list for Aetna, Pg 32 Original policy
J3387Skysona/Lenti-D (elivaldogene autotemcel or eli- cel) — precertification required for the drug and site of care. Contact National Medical ExcellenceParticipating provider precertification list for Aetna, Pg 32 Original policy
J1932Somatostatin agents: Lanreotide (cipla) — precertification required for the drug and site of careParticipating provider precertification list for Aetna, Pg 32 Original policy
J2354Somatostatin agents: Sandostatin (octreotide)Participating provider precertification list for Aetna, Pg 32 Original policy
J2353Somatostatin agents: Sandostatin LAR (octreotide acetate) — precertification required for the drug and site ofParticipating provider precertification list for Aetna, Pg 32 Original policy
J3490Somatostatin agents: Signifor (pasireotide) — precertification required for CommercialParticipating provider precertification list for Aetna, Pg 32 Original policy
J3590Somatostatin agents: Signifor (pasireotide) — precertification required for CommercialParticipating provider precertification list for Aetna, Pg 32 Original policy
J2502Somatostatin agents: Signifor LAR (pasireotide)Participating provider precertification list for Aetna, Pg 32 Original policy
J1930Somatostatin agents: Somatuline (lanreotide) — precertification required for the drug and site of careParticipating provider precertification list for Aetna, Pg 32 Original policy
J3490Somatostatin agents: Somavert (pegvisomant) — precertification required for CommercialParticipating provider precertification list for Aetna, Pg 32 Original policy
J3590Somatostatin agents: Somavert (pegvisomant) — precertification required for CommercialParticipating provider precertification list for Aetna, Pg 32 Original policy
J2326Spinraza (nusinersen) — precertification required for the drug and site of careParticipating provider precertification list for Aetna, Pg 32 Original policy
J0013Spravato (esketamine)Participating provider precertification list for Aetna, Pg 32 Original policy
90378Synagis (palivizumab)Participating provider precertification list for Aetna, Pg 32 Original policy
J3055Talvey (talquetamab-tgvs)Participating provider precertification list for Aetna, Pg 32 Original policy
Q2057Tecelra (afamitresgene autoleucel) — precertification required for the drug and site of care Contact National Medical ExcellenceParticipating provider precertification list for Aetna, Pg 32 Original policy
J9380Tecvayli (teclistamab-cqyv)Participating provider precertification list for Aetna, Pg 32 Original policy
J9273Tivdak (tisotumab vedotin-tftv)Participating provider precertification list for Aetna, Pg 32 Original policy
J9033Treanda (bendamustine HCl) — precertification required for Medicare members only effective July 1, 2026Participating provider precertification list for Aetna, Pg 33 Original policy
J3490Tregzi (T cells-vldq,)— precertification required effective August 1, 2026Participating provider precertification list for Aetna, Pg 33 Original policy
J3590Tregzi (T cells-vldq,)— precertification required effective August 1, 2026Participating provider precertification list for Aetna, Pg 33 Original policy
C9399Tregzi (T cells-vldq,)— precertification required effective August 1, 2026Participating provider precertification list for Aetna, Pg 33 Original policy
J9317Trodelvy (sacituzumab govitecan-hziy)Participating provider precertification list for Aetna, Pg 33 Original policy
J3490Tudriqev (vusolimogene oderparepvec) — precertification required effective October 1, 2026 Contact National Medical ExcellenceParticipating provider precertification list for Aetna, Pg 33 Original policy
J3590Tudriqev (vusolimogene oderparepvec) — precertification required effective October 1, 2026 Contact National Medical ExcellenceParticipating provider precertification list for Aetna, Pg 33 Original policy
C9399Tudriqev (vusolimogene oderparepvec) — precertification required effective October 1, 2026 Contact National Medical ExcellenceParticipating provider precertification list for Aetna, Pg 33 Original policy
J9381Tzield (teplizumab-mzwv)Participating provider precertification list for Aetna, Pg 33 Original policy
J1823Uplizna (inebilizumab-cdon) — precertification required for the drug and site of careParticipating provider precertification list for Aetna, Pg 33 Original policy
J9303Vectibix (panitumumab)Participating provider precertification list for Aetna, Pg 33 Original policy
Q5129Vegzelma (bevacizumab-adcd) — precertificatoin required for the drug and site of care for oncology indicationsParticipating provider precertification list for Aetna, Pg 33 Original policy
J9041Velcade (bortezomib) Commercial plans only effective October 1, 2026 — precertification required for multiple myeloma onlyParticipating provider precertification list for Aetna, Pg 33 Original policy
J1756Venofer (iron sucrose)— precertification required for Commercial members only effective August 1, 2026Participating provider precertification list for Aetna, Pg 33 Original policy
J7318Viscosupplements: Durolane (Hyaluronic acid) — precertification required for CommercialParticipating provider precertification list for Aetna, Pg 33 Original policy
J7323Viscosupplements: Euflexxa (1% sodium hyaluronate) — precertification required for CommercialParticipating provider precertification list for Aetna, Pg 33 Original policy
J7326Viscosupplements: Gel-One (cross-linked hyaluronate)Participating provider precertification list for Aetna, Pg 33 Original policy
J7328Viscosupplements: Gelsyn-3 (sodium hyaluronate 0.84%)Participating provider precertification list for Aetna, Pg 33 Original policy
J7320Viscosupplements: Genvisc 850 (sodium hyaluronate)Participating provider precertification list for Aetna, Pg 33 Original policy
J7321Viscosupplements: Hyalgan (sodium hyaluronate)Participating provider precertification list for Aetna, Pg 33 Original policy
J7322Viscosupplements: hyaluronan)Participating provider precertification list for Aetna, Pg 33 Original policy
J7322Viscosupplements: Hymovis One (viscoelastic hyaluronan) — precertification required effective April 1, 2026Participating provider precertification list for Aetna, Pg 33 Original policy
J7327Viscosupplements: Monovisc (high molecular weight hyaluronan)Participating provider precertification list for Aetna, Pg 33 Original policy
J7324Viscosupplements:)— precertification required for MedicareParticipating provider precertification list for Aetna, Pg 33 Original policy
J7321Viscosupplements: Supartz FX (sodium hyaluronate)Participating provider precertification list for Aetna, Pg 33 Original policy
J7331Viscosupplements: Synojoynt (1% sodium hyaluronate)Participating provider precertification list for Aetna, Pg 33 Original policy
J7325Viscosupplements: Synvisc, Synvisc-One* (hylan G-F 20) — precertification required for commercialParticipating provider precertification list for Aetna, Pg 33 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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