Aetna prior authorization and CPT code lookup, page 3
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 |
|---|---|---|
| K0870 | Electric or motorized wheelchairs | Participating provider precertification list for Aetna, Pg 8 Original policy |
| K0871 | Electric or motorized wheelchairs | Participating provider precertification list for Aetna, Pg 8 Original policy |
| K0877 | Electric or motorized wheelchairs | Participating provider precertification list for Aetna, Pg 8 Original policy |
| K0878 | Electric or motorized wheelchairs | Participating provider precertification list for Aetna, Pg 8 Original policy |
| K0879 | Electric or motorized wheelchairs | Participating provider precertification list for Aetna, Pg 8 Original policy |
| K0880 | Electric or motorized wheelchairs | Participating provider precertification list for Aetna, Pg 8 Original policy |
| K0884 | Electric or motorized wheelchairs | Participating provider precertification list for Aetna, Pg 8 Original policy |
| K0885 | Electric or motorized wheelchairs | Participating provider precertification list for Aetna, Pg 8 Original policy |
| K0886 | Electric or motorized wheelchairs | Participating provider precertification list for Aetna, Pg 8 Original policy |
| K0890 | Electric or motorized wheelchairs | Participating provider precertification list for Aetna, Pg 8 Original policy |
| K0891 | Electric or motorized wheelchairs | Participating provider precertification list for Aetna, Pg 8 Original policy |
| K0898 | Electric or motorized wheelchairs | Participating provider precertification list for Aetna, Pg 8 Original policy |
| K0899 | Electric or motorized wheelchairs | Participating provider precertification list for Aetna, Pg 8 Original policy |
| 31295 | Endoscopic nasal balloon dilation procedures* | Participating provider precertification list for Aetna, Pg 8 Original policy |
| 31296 | Endoscopic nasal balloon dilation procedures* | Participating provider precertification list for Aetna, Pg 8 Original policy |
| 31297 | Endoscopic nasal balloon dilation procedures* | Participating provider precertification list for Aetna, Pg 8 Original policy |
| 31298 | Endoscopic nasal balloon dilation procedures* | Participating provider precertification list for Aetna, Pg 8 Original policy |
| 31253 | Functional endoscopic sinus surgery (FESS)* | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 31254 | Functional endoscopic sinus surgery (FESS)* | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 31255 | Functional endoscopic sinus surgery (FESS)* | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 31256 | Functional endoscopic sinus surgery (FESS)* | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 31257 | Functional endoscopic sinus surgery (FESS)* | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 31259 | Functional endoscopic sinus surgery (FESS)* | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 31267 | Functional endoscopic sinus surgery (FESS)* | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 31276 | Functional endoscopic sinus surgery (FESS)* | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 31287 | Functional endoscopic sinus surgery (FESS)* | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 31288 | Functional endoscopic sinus surgery (FESS)* | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 55970 | Gender affirmation surgery | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 55980 | Gender affirmation surgery | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 56805 | Gender affirmation surgery | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 57335 | Gender affirmation surgery | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 11950 | Gender affirmation surgery | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 11951 | Gender affirmation surgery | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 11952 | Gender affirmation surgery | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 11954 | Gender affirmation surgery | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 15771 | Gender affirmation surgery | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 15772 | Gender affirmation surgery | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 15775 | Gender affirmation surgery | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 15776 | Gender affirmation surgery | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 15780 | Gender affirmation surgery | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 15781 | Gender affirmation surgery | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 15782 | Gender affirmation surgery | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 15783 | Gender affirmation surgery | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 15786 | Gender affirmation surgery | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 15787 | Gender affirmation surgery | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 15788 | Gender affirmation surgery | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 15789 | Gender affirmation surgery | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 15792 | Gender affirmation surgery | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 15793 | Gender affirmation surgery | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 15824 | Gender affirmation surgery | Participating provider precertification list for Aetna, Pg 9 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.