Aetna prior authorization and CPT code lookup, page 4

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
15825Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
15826Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
15828Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
17380Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
19318Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
21270Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
30400Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
30410Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
30420Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
30430Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
30435Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
30450Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
53430Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
54125Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
54400Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
54401Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
54405Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
54406Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
54408Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
54410Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
54411Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
54415Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
54416Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
54417Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
54520Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
54660Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
54690Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
55175Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
55180Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
56625Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
56800Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
56810Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
57106Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
57107Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
57110Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
57111Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
57291Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
57292Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
58150Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
58180Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
58260Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
58262Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
58275Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
58280Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
58285Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
58290Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
58291Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
58541Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
58542Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
58543Gender 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.