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

Prior authorization codes
CodeDescriptionSource
58544Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
58550Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
58552Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
58553Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
58554Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
58570Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
58571Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
58572Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
58573Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
58661Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
58720Gender affirmation surgeryParticipating provider precertification list for Aetna, Pg 9 Original policy
27146Hip osteotomyParticipating provider precertification list for Aetna, Pg 9 Original policy
S2115Hip osteotomyParticipating provider precertification list for Aetna, Pg 9 Original policy
96547Hyperthermic intraperitoneal chemotherapy (HIPEC)Participating provider precertification list for Aetna, Pg 9 Original policy
96548Hyperthermic intraperitoneal chemotherapy (HIPEC)Participating provider precertification list for Aetna, Pg 9 Original policy
G0277Hyperbaric oxygen therapy precertification required forParticipating provider precertification list for Aetna, Pg 9 Original policy
99183Hyperbaric oxygen therapy precertification required forParticipating provider precertification list for Aetna, Pg 9 Original policy
58970Infertility services and pre-implantation genetic testingParticipating provider precertification list for Aetna, Pg 9 Original policy
58974Infertility services and pre-implantation genetic testingParticipating provider precertification list for Aetna, Pg 9 Original policy
58976Infertility services and pre-implantation genetic testingParticipating provider precertification list for Aetna, Pg 9 Original policy
76948Infertility services and pre-implantation genetic testingParticipating provider precertification list for Aetna, Pg 9 Original policy
89250Infertility services and pre-implantation genetic testingParticipating provider precertification list for Aetna, Pg 9 Original policy
89251Infertility services and pre-implantation genetic testingParticipating provider precertification list for Aetna, Pg 9 Original policy
89253Infertility services and pre-implantation genetic testingParticipating provider precertification list for Aetna, Pg 9 Original policy
89254Infertility services and pre-implantation genetic testingParticipating provider precertification list for Aetna, Pg 9 Original policy
89255Infertility services and pre-implantation genetic testingParticipating provider precertification list for Aetna, Pg 9 Original policy
89257Infertility services and pre-implantation genetic testingParticipating provider precertification list for Aetna, Pg 9 Original policy
89258Infertility services and pre-implantation genetic testingParticipating provider precertification list for Aetna, Pg 9 Original policy
89264Infertility services and pre-implantation genetic testingParticipating provider precertification list for Aetna, Pg 9 Original policy
89268Infertility services and pre-implantation genetic testingParticipating provider precertification list for Aetna, Pg 9 Original policy
89272Infertility services and pre-implantation genetic testingParticipating provider precertification list for Aetna, Pg 9 Original policy
89280Infertility services and pre-implantation genetic testingParticipating provider precertification list for Aetna, Pg 9 Original policy
89281Infertility services and pre-implantation genetic testingParticipating provider precertification list for Aetna, Pg 9 Original policy
89290Infertility services and pre-implantation genetic testingParticipating provider precertification list for Aetna, Pg 9 Original policy
89291Infertility services and pre-implantation genetic testingParticipating provider precertification list for Aetna, Pg 9 Original policy
89337Infertility services and pre-implantation genetic testingParticipating provider precertification list for Aetna, Pg 9 Original policy
89342Infertility services and pre-implantation genetic testingParticipating provider precertification list for Aetna, Pg 9 Original policy
89346Infertility services and pre-implantation genetic testingParticipating provider precertification list for Aetna, Pg 9 Original policy
S4011Infertility services and pre-implantation genetic testingParticipating provider precertification list for Aetna, Pg 9 Original policy
S4013Infertility services and pre-implantation genetic testingParticipating provider precertification list for Aetna, Pg 9 Original policy
S4014Infertility services and pre-implantation genetic testingParticipating provider precertification list for Aetna, Pg 9 Original policy
S4015Infertility services and pre-implantation genetic testingParticipating provider precertification list for Aetna, Pg 9 Original policy
S4016Infertility services and pre-implantation genetic testingParticipating provider precertification list for Aetna, Pg 9 Original policy
S4017Infertility services and pre-implantation genetic testingParticipating provider precertification list for Aetna, Pg 9 Original policy
S4018Infertility services and pre-implantation genetic testingParticipating provider precertification list for Aetna, Pg 9 Original policy
S4020Infertility services and pre-implantation genetic testingParticipating provider precertification list for Aetna, Pg 9 Original policy
S4021Infertility services and pre-implantation genetic testingParticipating provider precertification list for Aetna, Pg 9 Original policy
S4022Infertility services and pre-implantation genetic testingParticipating provider precertification list for Aetna, Pg 9 Original policy
S4023Infertility services and pre-implantation genetic testingParticipating provider precertification list for Aetna, Pg 9 Original policy
S4025Infertility services and pre-implantation genetic testingParticipating 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.