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
| Code | Description | Source |
|---|---|---|
| 89250 | Infertility program — | Participating provider precertification list for Aetna, Pg 38 Original policy |
| 89251 | Infertility program — | Participating provider precertification list for Aetna, Pg 38 Original policy |
| 89253 | Infertility program — | Participating provider precertification list for Aetna, Pg 38 Original policy |
| 89254 | Infertility program — | Participating provider precertification list for Aetna, Pg 38 Original policy |
| 89255 | Infertility program — | Participating provider precertification list for Aetna, Pg 38 Original policy |
| 89257 | Infertility program — | Participating provider precertification list for Aetna, Pg 38 Original policy |
| 89258 | Infertility program — | Participating provider precertification list for Aetna, Pg 38 Original policy |
| 89264 | Infertility program — | Participating provider precertification list for Aetna, Pg 38 Original policy |
| 89268 | Infertility program — | Participating provider precertification list for Aetna, Pg 38 Original policy |
| 89272 | Infertility program — | Participating provider precertification list for Aetna, Pg 38 Original policy |
| 89280 | Infertility program — | Participating provider precertification list for Aetna, Pg 38 Original policy |
| 89281 | Infertility program — | Participating provider precertification list for Aetna, Pg 38 Original policy |
| 89337 | Infertility program — | Participating provider precertification list for Aetna, Pg 38 Original policy |
| 89342 | Infertility program — | Participating provider precertification list for Aetna, Pg 38 Original policy |
| 89346 | Infertility program — | Participating provider precertification list for Aetna, Pg 38 Original policy |
| 89352 | Infertility program — | Participating provider precertification list for Aetna, Pg 38 Original policy |
| S4011 | Infertility program — | Participating provider precertification list for Aetna, Pg 38 Original policy |
| S4013 | Infertility program — | Participating provider precertification list for Aetna, Pg 38 Original policy |
| S4016 | Infertility program — | Participating provider precertification list for Aetna, Pg 38 Original policy |
| S4017 | Infertility program — | Participating provider precertification list for Aetna, Pg 38 Original policy |
| S4018 | Infertility program — | Participating provider precertification list for Aetna, Pg 38 Original policy |
| S4020 | Infertility program — | Participating provider precertification list for Aetna, Pg 38 Original policy |
| S4021 | Infertility program — | Participating provider precertification list for Aetna, Pg 38 Original policy |
| S4022 | Infertility program — | Participating provider precertification list for Aetna, Pg 38 Original policy |
| S4023 | Infertility program — | Participating provider precertification list for Aetna, Pg 38 Original policy |
| S4025 | Infertility program — | Participating provider precertification list for Aetna, Pg 38 Original policy |
| 27096 | Pain management | Participating provider precertification list for Aetna, Pg 41 Original policy |
| 62320 | Pain management | Participating provider precertification list for Aetna, Pg 41 Original policy |
| 62321 | Pain management | Participating provider precertification list for Aetna, Pg 41 Original policy |
| 62322 | Pain management | Participating provider precertification list for Aetna, Pg 41 Original policy |
| 62323 | Pain management | Participating provider precertification list for Aetna, Pg 41 Original policy |
| 62324 | Pain management | Participating provider precertification list for Aetna, Pg 41 Original policy |
| 62325 | Pain management | Participating provider precertification list for Aetna, Pg 41 Original policy |
| 62326 | Pain management | Participating provider precertification list for Aetna, Pg 41 Original policy |
| 62327 | Pain management | Participating provider precertification list for Aetna, Pg 41 Original policy |
| 64479 | Pain management | Participating provider precertification list for Aetna, Pg 41 Original policy |
| 64480 | Pain management | Participating provider precertification list for Aetna, Pg 41 Original policy |
| 64483 | Pain management | Participating provider precertification list for Aetna, Pg 41 Original policy |
| 64484 | Pain management | Participating provider precertification list for Aetna, Pg 41 Original policy |
| 64490 | Pain management | Participating provider precertification list for Aetna, Pg 41 Original policy |
| 64491 | Pain management | Participating provider precertification list for Aetna, Pg 41 Original policy |
| 64492 | Pain management | Participating provider precertification list for Aetna, Pg 41 Original policy |
| 64493 | Pain management | Participating provider precertification list for Aetna, Pg 41 Original policy |
| 64494 | Pain management | Participating provider precertification list for Aetna, Pg 41 Original policy |
| 64495 | Pain management | Participating provider precertification list for Aetna, Pg 41 Original policy |
| 64510 | Pain management | Participating provider precertification list for Aetna, Pg 41 Original policy |
| 64520 | Pain management | Participating provider precertification list for Aetna, Pg 41 Original policy |
| 64633 | Pain management | Participating provider precertification list for Aetna, Pg 41 Original policy |
| 64634 | Pain management | Participating provider precertification list for Aetna, Pg 41 Original policy |
| 64635 | Pain management | Participating 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.
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.