Aetna prior authorization and CPT code lookup, page 27

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
89250Infertility program —Participating provider precertification list for Aetna, Pg 38 Original policy
89251Infertility program —Participating provider precertification list for Aetna, Pg 38 Original policy
89253Infertility program —Participating provider precertification list for Aetna, Pg 38 Original policy
89254Infertility program —Participating provider precertification list for Aetna, Pg 38 Original policy
89255Infertility program —Participating provider precertification list for Aetna, Pg 38 Original policy
89257Infertility program —Participating provider precertification list for Aetna, Pg 38 Original policy
89258Infertility program —Participating provider precertification list for Aetna, Pg 38 Original policy
89264Infertility program —Participating provider precertification list for Aetna, Pg 38 Original policy
89268Infertility program —Participating provider precertification list for Aetna, Pg 38 Original policy
89272Infertility program —Participating provider precertification list for Aetna, Pg 38 Original policy
89280Infertility program —Participating provider precertification list for Aetna, Pg 38 Original policy
89281Infertility program —Participating provider precertification list for Aetna, Pg 38 Original policy
89337Infertility program —Participating provider precertification list for Aetna, Pg 38 Original policy
89342Infertility program —Participating provider precertification list for Aetna, Pg 38 Original policy
89346Infertility program —Participating provider precertification list for Aetna, Pg 38 Original policy
89352Infertility program —Participating provider precertification list for Aetna, Pg 38 Original policy
S4011Infertility program —Participating provider precertification list for Aetna, Pg 38 Original policy
S4013Infertility program —Participating provider precertification list for Aetna, Pg 38 Original policy
S4016Infertility program —Participating provider precertification list for Aetna, Pg 38 Original policy
S4017Infertility program —Participating provider precertification list for Aetna, Pg 38 Original policy
S4018Infertility program —Participating provider precertification list for Aetna, Pg 38 Original policy
S4020Infertility program —Participating provider precertification list for Aetna, Pg 38 Original policy
S4021Infertility program —Participating provider precertification list for Aetna, Pg 38 Original policy
S4022Infertility program —Participating provider precertification list for Aetna, Pg 38 Original policy
S4023Infertility program —Participating provider precertification list for Aetna, Pg 38 Original policy
S4025Infertility program —Participating provider precertification list for Aetna, Pg 38 Original policy
27096Pain managementParticipating provider precertification list for Aetna, Pg 41 Original policy
62320Pain managementParticipating provider precertification list for Aetna, Pg 41 Original policy
62321Pain managementParticipating provider precertification list for Aetna, Pg 41 Original policy
62322Pain managementParticipating provider precertification list for Aetna, Pg 41 Original policy
62323Pain managementParticipating provider precertification list for Aetna, Pg 41 Original policy
62324Pain managementParticipating provider precertification list for Aetna, Pg 41 Original policy
62325Pain managementParticipating provider precertification list for Aetna, Pg 41 Original policy
62326Pain managementParticipating provider precertification list for Aetna, Pg 41 Original policy
62327Pain managementParticipating provider precertification list for Aetna, Pg 41 Original policy
64479Pain managementParticipating provider precertification list for Aetna, Pg 41 Original policy
64480Pain managementParticipating provider precertification list for Aetna, Pg 41 Original policy
64483Pain managementParticipating provider precertification list for Aetna, Pg 41 Original policy
64484Pain managementParticipating provider precertification list for Aetna, Pg 41 Original policy
64490Pain managementParticipating provider precertification list for Aetna, Pg 41 Original policy
64491Pain managementParticipating provider precertification list for Aetna, Pg 41 Original policy
64492Pain managementParticipating provider precertification list for Aetna, Pg 41 Original policy
64493Pain managementParticipating provider precertification list for Aetna, Pg 41 Original policy
64494Pain managementParticipating provider precertification list for Aetna, Pg 41 Original policy
64495Pain managementParticipating provider precertification list for Aetna, Pg 41 Original policy
64510Pain managementParticipating provider precertification list for Aetna, Pg 41 Original policy
64520Pain managementParticipating provider precertification list for Aetna, Pg 41 Original policy
64633Pain managementParticipating provider precertification list for Aetna, Pg 41 Original policy
64634Pain managementParticipating provider precertification list for Aetna, Pg 41 Original policy
64635Pain managementParticipating provider precertification list for Aetna, Pg 41 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.