Aetna prior authorization and CPT code lookup, page 5
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 |
|---|---|---|
| 58544 | Gender affirmation surgery | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 58550 | Gender affirmation surgery | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 58552 | Gender affirmation surgery | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 58553 | Gender affirmation surgery | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 58554 | Gender affirmation surgery | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 58570 | Gender affirmation surgery | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 58571 | Gender affirmation surgery | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 58572 | Gender affirmation surgery | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 58573 | Gender affirmation surgery | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 58661 | Gender affirmation surgery | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 58720 | Gender affirmation surgery | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 27146 | Hip osteotomy | Participating provider precertification list for Aetna, Pg 9 Original policy |
| S2115 | Hip osteotomy | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 96547 | Hyperthermic intraperitoneal chemotherapy (HIPEC) | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 96548 | Hyperthermic intraperitoneal chemotherapy (HIPEC) | Participating provider precertification list for Aetna, Pg 9 Original policy |
| G0277 | Hyperbaric oxygen therapy precertification required for | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 99183 | Hyperbaric oxygen therapy precertification required for | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 58970 | Infertility services and pre-implantation genetic testing | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 58974 | Infertility services and pre-implantation genetic testing | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 58976 | Infertility services and pre-implantation genetic testing | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 76948 | Infertility services and pre-implantation genetic testing | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 89250 | Infertility services and pre-implantation genetic testing | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 89251 | Infertility services and pre-implantation genetic testing | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 89253 | Infertility services and pre-implantation genetic testing | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 89254 | Infertility services and pre-implantation genetic testing | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 89255 | Infertility services and pre-implantation genetic testing | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 89257 | Infertility services and pre-implantation genetic testing | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 89258 | Infertility services and pre-implantation genetic testing | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 89264 | Infertility services and pre-implantation genetic testing | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 89268 | Infertility services and pre-implantation genetic testing | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 89272 | Infertility services and pre-implantation genetic testing | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 89280 | Infertility services and pre-implantation genetic testing | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 89281 | Infertility services and pre-implantation genetic testing | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 89290 | Infertility services and pre-implantation genetic testing | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 89291 | Infertility services and pre-implantation genetic testing | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 89337 | Infertility services and pre-implantation genetic testing | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 89342 | Infertility services and pre-implantation genetic testing | Participating provider precertification list for Aetna, Pg 9 Original policy |
| 89346 | Infertility services and pre-implantation genetic testing | Participating provider precertification list for Aetna, Pg 9 Original policy |
| S4011 | Infertility services and pre-implantation genetic testing | Participating provider precertification list for Aetna, Pg 9 Original policy |
| S4013 | Infertility services and pre-implantation genetic testing | Participating provider precertification list for Aetna, Pg 9 Original policy |
| S4014 | Infertility services and pre-implantation genetic testing | Participating provider precertification list for Aetna, Pg 9 Original policy |
| S4015 | Infertility services and pre-implantation genetic testing | Participating provider precertification list for Aetna, Pg 9 Original policy |
| S4016 | Infertility services and pre-implantation genetic testing | Participating provider precertification list for Aetna, Pg 9 Original policy |
| S4017 | Infertility services and pre-implantation genetic testing | Participating provider precertification list for Aetna, Pg 9 Original policy |
| S4018 | Infertility services and pre-implantation genetic testing | Participating provider precertification list for Aetna, Pg 9 Original policy |
| S4020 | Infertility services and pre-implantation genetic testing | Participating provider precertification list for Aetna, Pg 9 Original policy |
| S4021 | Infertility services and pre-implantation genetic testing | Participating provider precertification list for Aetna, Pg 9 Original policy |
| S4022 | Infertility services and pre-implantation genetic testing | Participating provider precertification list for Aetna, Pg 9 Original policy |
| S4023 | Infertility services and pre-implantation genetic testing | Participating provider precertification list for Aetna, Pg 9 Original policy |
| S4025 | Infertility services and pre-implantation genetic testing | 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.