Aetna prior authorization and CPT code lookup, page 28
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 |
|---|---|---|
| 64636 | Pain management | Participating provider precertification list for Aetna, Pg 41 Original policy |
| 0213T | Pain management | Participating provider precertification list for Aetna, Pg 41 Original policy |
| 0214T | Pain management | Participating provider precertification list for Aetna, Pg 41 Original policy |
| 0215T | Pain management | Participating provider precertification list for Aetna, Pg 41 Original policy |
| 0216T | Pain management | Participating provider precertification list for Aetna, Pg 41 Original policy |
| 0217T | Pain management | Participating provider precertification list for Aetna, Pg 41 Original policy |
| 0218T | Pain management | Participating provider precertification list for Aetna, Pg 41 Original policy |
| 0627T | Pain management | Participating provider precertification list for Aetna, Pg 41 Original policy |
| 0628T | Pain management | Participating provider precertification list for Aetna, Pg 41 Original policy |
| 0629T | Pain management | Participating provider precertification list for Aetna, Pg 41 Original policy |
| 0630T | Pain management | Participating provider precertification list for Aetna, Pg 41 Original policy |
| G0259 | Pain management | Participating provider precertification list for Aetna, Pg 41 Original policy |
| G0260 | Pain management | Participating provider precertification list for Aetna, Pg 41 Original policy |
| 37254 | Peripheral arterial disease (PVD) | Participating provider precertification list for Aetna, Pg 42 Original policy |
| 37255 | Peripheral arterial disease (PVD) | Participating provider precertification list for Aetna, Pg 42 Original policy |
| 37256 | Peripheral arterial disease (PVD) | Participating provider precertification list for Aetna, Pg 42 Original policy |
| 37257 | Peripheral arterial disease (PVD) | Participating provider precertification list for Aetna, Pg 42 Original policy |
| 37258 | Peripheral arterial disease (PVD) | Participating provider precertification list for Aetna, Pg 42 Original policy |
| 37259 | Peripheral arterial disease (PVD) | Participating provider precertification list for Aetna, Pg 42 Original policy |
| 37260 | Peripheral arterial disease (PVD) | Participating provider precertification list for Aetna, Pg 42 Original policy |
| 37261 | Peripheral arterial disease (PVD) | Participating provider precertification list for Aetna, Pg 42 Original policy |
| 37262 | Peripheral arterial disease (PVD) | Participating provider precertification list for Aetna, Pg 42 Original policy |
| 37263 | Peripheral arterial disease (PVD) | Participating provider precertification list for Aetna, Pg 42 Original policy |
| 37264 | Peripheral arterial disease (PVD) | Participating provider precertification list for Aetna, Pg 42 Original policy |
| 37265 | Peripheral arterial disease (PVD) | Participating provider precertification list for Aetna, Pg 42 Original policy |
| 37266 | Peripheral arterial disease (PVD) | Participating provider precertification list for Aetna, Pg 42 Original policy |
| 37267 | Peripheral arterial disease (PVD) | Participating provider precertification list for Aetna, Pg 42 Original policy |
| 37268 | Peripheral arterial disease (PVD) | Participating provider precertification list for Aetna, Pg 42 Original policy |
| 37269 | Peripheral arterial disease (PVD) | Participating provider precertification list for Aetna, Pg 42 Original policy |
| 37270 | Peripheral arterial disease (PVD) | Participating provider precertification list for Aetna, Pg 42 Original policy |
| 37271 | Peripheral arterial disease (PVD) | Participating provider precertification list for Aetna, Pg 42 Original policy |
| 37272 | Peripheral arterial disease (PVD) | Participating provider precertification list for Aetna, Pg 42 Original policy |
| 37273 | Peripheral arterial disease (PVD) | Participating provider precertification list for Aetna, Pg 42 Original policy |
| 37274 | Peripheral arterial disease (PVD) | Participating provider precertification list for Aetna, Pg 42 Original policy |
| 37275 | Peripheral arterial disease (PVD) | Participating provider precertification list for Aetna, Pg 42 Original policy |
| 37276 | Peripheral arterial disease (PVD) | Participating provider precertification list for Aetna, Pg 42 Original policy |
| 37277 | Peripheral arterial disease (PVD) | Participating provider precertification list for Aetna, Pg 42 Original policy |
| 37278 | Peripheral arterial disease (PVD) | Participating provider precertification list for Aetna, Pg 42 Original policy |
| 37279 | Peripheral arterial disease (PVD) | Participating provider precertification list for Aetna, Pg 42 Original policy |
| 37280 | Peripheral arterial disease (PVD) | Participating provider precertification list for Aetna, Pg 42 Original policy |
| 37281 | Peripheral arterial disease (PVD) | Participating provider precertification list for Aetna, Pg 42 Original policy |
| 37282 | Peripheral arterial disease (PVD) | Participating provider precertification list for Aetna, Pg 42 Original policy |
| 37283 | Peripheral arterial disease (PVD) | Participating provider precertification list for Aetna, Pg 42 Original policy |
| 37284 | Peripheral arterial disease (PVD) | Participating provider precertification list for Aetna, Pg 42 Original policy |
| 37285 | Peripheral arterial disease (PVD) | Participating provider precertification list for Aetna, Pg 42 Original policy |
| 37286 | Peripheral arterial disease (PVD) | Participating provider precertification list for Aetna, Pg 42 Original policy |
| 37287 | Peripheral arterial disease (PVD) | Participating provider precertification list for Aetna, Pg 42 Original policy |
| 37288 | Peripheral arterial disease (PVD) | Participating provider precertification list for Aetna, Pg 42 Original policy |
| 37289 | Peripheral arterial disease (PVD) | Participating provider precertification list for Aetna, Pg 42 Original policy |
| 37290 | Peripheral arterial disease (PVD) | Participating provider precertification list for Aetna, Pg 42 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.