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

Prior authorization codes
CodeDescriptionSource
K0870Electric or motorized wheelchairsParticipating provider precertification list for Aetna, Pg 8 Original policy
K0871Electric or motorized wheelchairsParticipating provider precertification list for Aetna, Pg 8 Original policy
K0877Electric or motorized wheelchairsParticipating provider precertification list for Aetna, Pg 8 Original policy
K0878Electric or motorized wheelchairsParticipating provider precertification list for Aetna, Pg 8 Original policy
K0879Electric or motorized wheelchairsParticipating provider precertification list for Aetna, Pg 8 Original policy
K0880Electric or motorized wheelchairsParticipating provider precertification list for Aetna, Pg 8 Original policy
K0884Electric or motorized wheelchairsParticipating provider precertification list for Aetna, Pg 8 Original policy
K0885Electric or motorized wheelchairsParticipating provider precertification list for Aetna, Pg 8 Original policy
K0886Electric or motorized wheelchairsParticipating provider precertification list for Aetna, Pg 8 Original policy
K0890Electric or motorized wheelchairsParticipating provider precertification list for Aetna, Pg 8 Original policy
K0891Electric or motorized wheelchairsParticipating provider precertification list for Aetna, Pg 8 Original policy
K0898Electric or motorized wheelchairsParticipating provider precertification list for Aetna, Pg 8 Original policy
K0899Electric or motorized wheelchairsParticipating provider precertification list for Aetna, Pg 8 Original policy
31295Endoscopic nasal balloon dilation procedures*Participating provider precertification list for Aetna, Pg 8 Original policy
31296Endoscopic nasal balloon dilation procedures*Participating provider precertification list for Aetna, Pg 8 Original policy
31297Endoscopic nasal balloon dilation procedures*Participating provider precertification list for Aetna, Pg 8 Original policy
31298Endoscopic nasal balloon dilation procedures*Participating provider precertification list for Aetna, Pg 8 Original policy
31253Functional endoscopic sinus surgery (FESS)*Participating provider precertification list for Aetna, Pg 9 Original policy
31254Functional endoscopic sinus surgery (FESS)*Participating provider precertification list for Aetna, Pg 9 Original policy
31255Functional endoscopic sinus surgery (FESS)*Participating provider precertification list for Aetna, Pg 9 Original policy
31256Functional endoscopic sinus surgery (FESS)*Participating provider precertification list for Aetna, Pg 9 Original policy
31257Functional endoscopic sinus surgery (FESS)*Participating provider precertification list for Aetna, Pg 9 Original policy
31259Functional endoscopic sinus surgery (FESS)*Participating provider precertification list for Aetna, Pg 9 Original policy
31267Functional endoscopic sinus surgery (FESS)*Participating provider precertification list for Aetna, Pg 9 Original policy
31276Functional endoscopic sinus surgery (FESS)*Participating provider precertification list for Aetna, Pg 9 Original policy
31287Functional endoscopic sinus surgery (FESS)*Participating provider precertification list for Aetna, Pg 9 Original policy
31288Functional endoscopic sinus surgery (FESS)*Participating provider precertification list for Aetna, Pg 9 Original policy
55970Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
55980Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
56805Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
57335Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
11950Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
11951Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
11952Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
11954Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
15771Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
15772Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
15775Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
15776Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
15780Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
15781Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
15782Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
15783Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
15786Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
15787Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
15788Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
15789Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
15792Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
15793Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
15824Gender affirmation surgeryParticipating 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.

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.