Aetna prior authorization and CPT code lookup, page 24
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
| Code | Description | Source |
|---|---|---|
| J7332 | Viscosupplements: Triluron (sodium hyaluronate) | Participating provider precertification list for Aetna, Pg 33 Original policy |
| J7329 | Viscosupplements: TriVisc (sodium hyaluronate) | Participating provider precertification list for Aetna, Pg 33 Original policy |
| J7321 | Viscosupplements: Visco 3 (sodium hyaluronate) | Participating provider precertification list for Aetna, Pg 33 Original policy |
| J9056 | Vivimusta (bendamustine hydrochloride) | Participating provider precertification list for Aetna, Pg 33 Original policy |
| J3490 | Vyjuvek (beremagene geperpavec,) | Participating provider precertification list for Aetna, Pg 33 Original policy |
| J3590 | Vyjuvek (beremagene geperpavec,) | Participating provider precertification list for Aetna, Pg 33 Original policy |
| C9399 | Vyjuvek (beremagene geperpavec,) | Participating provider precertification list for Aetna, Pg 33 Original policy |
| J1326 | Vyloy (zolbetuximab-clzb) | Participating provider precertification list for Aetna, Pg 33 Original policy |
| J3386 | Waskyra (etuvetidigene autotemcel) — precertification required for the drug and site of care effective April 1, 2026 Contact National Medical Excellence | Participating provider precertification list for Aetna, Pg 34 Original policy |
| J1289 | Yartemlea (narsoplimab) — precertification required effective April 1, 2026 | Participating provider precertification list for Aetna, Pg 34 Original policy |
| J9228 | Yervoy (ipilimumab) — precertification required for the drug and site of care Yondelis (trabectedin) | Participating provider precertification list for Aetna, Pg 34 Original policy |
| J9362 | Yervoy (ipilimumab) — precertification required for the drug and site of care Yondelis (trabectedin) | Participating provider precertification list for Aetna, Pg 34 Original policy |
| J3490 | Zanvastro (zilganersen,)— precertification required effective October 1, 2026 | Participating provider precertification list for Aetna, Pg 34 Original policy |
| J3590 | Zanvastro (zilganersen,)— precertification required effective October 1, 2026 | Participating provider precertification list for Aetna, Pg 34 Original policy |
| C9399 | Zanvastro (zilganersen,)— precertification required effective October 1, 2026 | Participating provider precertification list for Aetna, Pg 34 Original policy |
| J9223 | Zepzelca (lurbinectedin) Zevaskyn (prademagene zamikeracel) — precertification required for the drug and site of care | Participating provider precertification list for Aetna, Pg 34 Original policy |
| J3389 | Zepzelca (lurbinectedin) Zevaskyn (prademagene zamikeracel) — precertification required for the drug and site of care | Participating provider precertification list for Aetna, Pg 34 Original policy |
| J3304 | Zilretta (triamcinolone acetonide extended release injectable suspension) — precertification required for Medicare Advantage members only | Participating provider precertification list for Aetna, Pg 34 Original policy |
| Q5118 | Zirabev (bevacizumab-bvzr) — precertification required for the drug and site of care for oncology indications only | Participating provider precertification list for Aetna, Pg 34 Original policy |
| J3399 | Zolgensma (onasemnogene abeparvovec-xioi) — precertification required for the drug and site of care Zusduri (mitomycin) | Participating provider precertification list for Aetna, Pg 34 Original policy |
| J9282 | Zolgensma (onasemnogene abeparvovec-xioi) — precertification required for the drug and site of care Zusduri (mitomycin) | Participating provider precertification list for Aetna, Pg 34 Original policy |
| J9359 | Zynlonta (loncastuximab tesirine-lpyl) | Participating provider precertification list for Aetna, Pg 34 Original policy |
| J3393 | Zynteglo (betibeglogene autotemcel) — precertification required for the drug and site of care | Participating provider precertification list for Aetna, Pg 34 Original policy |
| 81163 | Breast and ovarian cancer susceptibility screening (BRCA) | Participating provider precertification list for Aetna, Pg 35 Original policy |
| 81165 | Breast and ovarian cancer susceptibility screening (BRCA) | Participating provider precertification list for Aetna, Pg 35 Original policy |
| 81212 | Breast and ovarian cancer susceptibility screening (BRCA) | Participating provider precertification list for Aetna, Pg 35 Original policy |
| 81215 | Breast and ovarian cancer susceptibility screening (BRCA) | Participating provider precertification list for Aetna, Pg 35 Original policy |
| 81216 | Breast and ovarian cancer susceptibility screening (BRCA) | Participating provider precertification list for Aetna, Pg 35 Original policy |
| 81217 | Breast and ovarian cancer susceptibility screening (BRCA) | Participating provider precertification list for Aetna, Pg 35 Original policy |
| 81432 | Breast and ovarian cancer susceptibility screening (BRCA) | Participating provider precertification list for Aetna, Pg 35 Original policy |
| 81162 | Breast and ovarian cancer susceptibility screening (BRCA) (precertification required for Medicare Advantage members only) | Participating provider precertification list for Aetna, Pg 35 Original policy |
| 33206 | Diagnostic cardiology (cardiac rhythm implantable devices, cardiac catheterization) | Participating provider precertification list for Aetna, Pg 36 Original policy |
| 33207 | Diagnostic cardiology (cardiac rhythm implantable devices, cardiac catheterization) | Participating provider precertification list for Aetna, Pg 36 Original policy |
| 33208 | Diagnostic cardiology (cardiac rhythm implantable devices, cardiac catheterization) | Participating provider precertification list for Aetna, Pg 36 Original policy |
| 33212 | Diagnostic cardiology (cardiac rhythm implantable devices, cardiac catheterization) | Participating provider precertification list for Aetna, Pg 36 Original policy |
| 33213 | Diagnostic cardiology (cardiac rhythm implantable devices, cardiac catheterization) | Participating provider precertification list for Aetna, Pg 36 Original policy |
| 33214 | Diagnostic cardiology (cardiac rhythm implantable devices, cardiac catheterization) | Participating provider precertification list for Aetna, Pg 36 Original policy |
| 33221 | Diagnostic cardiology (cardiac rhythm implantable devices, cardiac catheterization) | Participating provider precertification list for Aetna, Pg 36 Original policy |
| 33224 | Diagnostic cardiology (cardiac rhythm implantable devices, cardiac catheterization) | Participating provider precertification list for Aetna, Pg 36 Original policy |
| 33225 | Diagnostic cardiology (cardiac rhythm implantable devices, cardiac catheterization) | Participating provider precertification list for Aetna, Pg 36 Original policy |
| 33227 | Diagnostic cardiology (cardiac rhythm implantable devices, cardiac catheterization) | Participating provider precertification list for Aetna, Pg 36 Original policy |
| 33228 | Diagnostic cardiology (cardiac rhythm implantable devices, cardiac catheterization) | Participating provider precertification list for Aetna, Pg 36 Original policy |
| 33229 | Diagnostic cardiology (cardiac rhythm implantable devices, cardiac catheterization) | Participating provider precertification list for Aetna, Pg 36 Original policy |
| 33230 | Diagnostic cardiology (cardiac rhythm implantable devices, cardiac catheterization) | Participating provider precertification list for Aetna, Pg 36 Original policy |
| 33231 | Diagnostic cardiology (cardiac rhythm implantable devices, cardiac catheterization) | Participating provider precertification list for Aetna, Pg 36 Original policy |
| 33240 | Diagnostic cardiology (cardiac rhythm implantable devices, cardiac catheterization) | Participating provider precertification list for Aetna, Pg 36 Original policy |
| 33249 | Diagnostic cardiology (cardiac rhythm implantable devices, cardiac catheterization) | Participating provider precertification list for Aetna, Pg 36 Original policy |
| 33262 | Diagnostic cardiology (cardiac rhythm implantable devices, cardiac catheterization) | Participating provider precertification list for Aetna, Pg 36 Original policy |
| 33263 | Diagnostic cardiology (cardiac rhythm implantable devices, cardiac catheterization) | Participating provider precertification list for Aetna, Pg 36 Original policy |
| 33264 | Diagnostic cardiology (cardiac rhythm implantable devices, cardiac catheterization) | Participating provider precertification list for Aetna, Pg 36 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.
Plan and setting exceptions
Student Health and Allina Health / Aetna are separate from the participating-provider rows above.
Prior authorization forms
| Product or plan | Benefit | Route |
|---|---|---|
| Use the plan named on the official form page | Medical and pharmacy forms are listed by Aetna | Aetna 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.