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Aetna prior authorization and CPT code lookup, page 33

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
77439Radiation oncologyParticipating provider precertification list for Aetna, Pg 44 Original policy
77600Radiation oncologyParticipating provider precertification list for Aetna, Pg 44 Original policy
77605Radiation oncologyParticipating provider precertification list for Aetna, Pg 44 Original policy
77610Radiation oncologyParticipating provider precertification list for Aetna, Pg 44 Original policy
77615Radiation oncologyParticipating provider precertification list for Aetna, Pg 44 Original policy
77620Radiation oncologyParticipating provider precertification list for Aetna, Pg 44 Original policy
77761Radiation oncologyParticipating provider precertification list for Aetna, Pg 44 Original policy
77762Radiation oncologyParticipating provider precertification list for Aetna, Pg 44 Original policy
77763Radiation oncologyParticipating provider precertification list for Aetna, Pg 44 Original policy
77767Radiation oncologyParticipating provider precertification list for Aetna, Pg 44 Original policy
77768Radiation oncologyParticipating provider precertification list for Aetna, Pg 44 Original policy
77770Radiation oncologyParticipating provider precertification list for Aetna, Pg 44 Original policy
77771Radiation oncologyParticipating provider precertification list for Aetna, Pg 44 Original policy
77772Radiation oncologyParticipating provider precertification list for Aetna, Pg 44 Original policy
77778Radiation oncologyParticipating provider precertification list for Aetna, Pg 44 Original policy
A9590Radiation oncologyParticipating provider precertification list for Aetna, Pg 44 Original policy
G0339Radiation oncologyParticipating provider precertification list for Aetna, Pg 44 Original policy
G0340Radiation oncologyParticipating provider precertification list for Aetna, Pg 44 Original policy
0395TRadiation oncologyParticipating provider precertification list for Aetna, Pg 44 Original policy
0747TRadiation oncologyParticipating provider precertification list for Aetna, Pg 44 Original policy
77520Radiation oncology Proton beam radiotherapy:,,Participating provider precertification list for Aetna, Pg 44 Original policy
77522Radiation oncology Proton beam radiotherapy:,,Participating provider precertification list for Aetna, Pg 44 Original policy
77523Radiation oncology Proton beam radiotherapy:,,Participating provider precertification list for Aetna, Pg 44 Original policy
77525Radiation oncology Proton beam radiotherapy:,,Participating provider precertification list for Aetna, Pg 44 Original policy
19120Site of service Breast tissue excisionParticipating provider precertification list for Aetna, Pg 45 Original policy
13101Site of service Complex wound repairParticipating provider precertification list for Aetna, Pg 45 Original policy
13132Site of service Complex wound repairParticipating provider precertification list for Aetna, Pg 45 Original policy
52000Site of service CystourethroscopyParticipating provider precertification list for Aetna, Pg 45 Original policy
30520Site of service SeptoplastyParticipating provider precertification list for Aetna, Pg 45 Original policy
14040Site of service Skin tissue transfer or rearrangementParticipating provider precertification list for Aetna, Pg 45 Original policy
14060Site of service Skin tissue transfer or rearrangementParticipating provider precertification list for Aetna, Pg 45 Original policy
14301Site of service Skin tissue transfer or rearrangementParticipating provider precertification list for Aetna, Pg 45 Original policy
23430Site of service Tenodesis of long tendon of bicepsParticipating provider precertification list for Aetna, Pg 45 Original policy
30140Site of service Turbinate resectionParticipating provider precertification list for Aetna, Pg 45 Original policy
81415Whole exome sequencing (WES) and whole genome sequencing (WGS)Participating provider precertification list for Aetna, Pg 45 Original policy
81416Whole exome sequencing (WES) and whole genome sequencing (WGS)Participating provider precertification list for Aetna, Pg 45 Original policy
81417Whole exome sequencing (WES) and whole genome sequencing (WGS)Participating provider precertification list for Aetna, Pg 45 Original policy
81425Whole exome sequencing (WES) and whole genome sequencing (WGS)Participating provider precertification list for Aetna, Pg 45 Original policy
81426Whole exome sequencing (WES) and whole genome sequencing (WGS)Participating provider precertification list for Aetna, Pg 45 Original policy
81427Whole exome sequencing (WES) and whole genome sequencing (WGS)Participating provider precertification list for Aetna, Pg 45 Original policy
0094UWhole exome sequencing (WES) and whole genome sequencing (WGS)Participating provider precertification list for Aetna, Pg 45 Original policy
0214UWhole exome sequencing (WES) and whole genome sequencing (WGS)Participating provider precertification list for Aetna, Pg 45 Original policy
0215UWhole exome sequencing (WES) and whole genome sequencing (WGS)Participating provider precertification list for Aetna, Pg 45 Original policy
0335UWhole exome sequencing (WES) and whole genome sequencing (WGS)Participating provider precertification list for Aetna, Pg 45 Original policy
0336UWhole exome sequencing (WES) and whole genome sequencing (WGS)Participating provider precertification list for Aetna, Pg 45 Original policy
0425UWhole exome sequencing (WES) and whole genome sequencing (WGS)Participating provider precertification list for Aetna, Pg 45 Original policy
0426UWhole exome sequencing (WES) and whole genome sequencing (WGS)Participating provider precertification list for Aetna, Pg 45 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.

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