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Aetna prior authorization and CPT code lookup, page 6

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
27415Osteochondral allograft/knee*Participating provider precertification list for Aetna, Pg 9 Original policy
29875Knee arthroscopy precertificationParticipating provider precertification list for Aetna, Pg 10 Original policy
29876Knee arthroscopy precertificationParticipating provider precertification list for Aetna, Pg 10 Original policy
29877Knee arthroscopy precertificationParticipating provider precertification list for Aetna, Pg 10 Original policy
29879Knee arthroscopy precertificationParticipating provider precertification list for Aetna, Pg 10 Original policy
29875Knee meniscectomy precertificationParticipating provider precertification list for Aetna, Pg 10 Original policy
29876Knee meniscectomy precertificationParticipating provider precertification list for Aetna, Pg 10 Original policy
29877Knee meniscectomy precertificationParticipating provider precertification list for Aetna, Pg 10 Original policy
29879Knee meniscectomy precertificationParticipating provider precertification list for Aetna, Pg 10 Original policy
L5781Lower limb prosthetics, such as microprocessor- controlled lower limb prostheticsParticipating provider precertification list for Aetna, Pg 10 Original policy
L5782Lower limb prosthetics, such as microprocessor- controlled lower limb prostheticsParticipating provider precertification list for Aetna, Pg 10 Original policy
L5856Lower limb prosthetics, such as microprocessor- controlled lower limb prostheticsParticipating provider precertification list for Aetna, Pg 10 Original policy
L5857Lower limb prosthetics, such as microprocessor- controlled lower limb prostheticsParticipating provider precertification list for Aetna, Pg 10 Original policy
L5858Lower limb prosthetics, such as microprocessor- controlled lower limb prostheticsParticipating provider precertification list for Aetna, Pg 10 Original policy
L5859Lower limb prosthetics, such as microprocessor- controlled lower limb prostheticsParticipating provider precertification list for Aetna, Pg 10 Original policy
L5926Lower limb prosthetics, such as microprocessor- controlled lower limb prostheticsParticipating provider precertification list for Aetna, Pg 10 Original policy
L5968Lower limb prosthetics, such as microprocessor- controlled lower limb prostheticsParticipating provider precertification list for Aetna, Pg 10 Original policy
L5969Lower limb prosthetics, such as microprocessor- controlled lower limb prostheticsParticipating provider precertification list for Aetna, Pg 10 Original policy
L5973Lower limb prosthetics, such as microprocessor- controlled lower limb prostheticsParticipating provider precertification list for Aetna, Pg 10 Original policy
L5980Lower limb prosthetics, such as microprocessor- controlled lower limb prostheticsParticipating provider precertification list for Aetna, Pg 10 Original policy
L5987Lower limb prosthetics, such as microprocessor- controlled lower limb prostheticsParticipating provider precertification list for Aetna, Pg 10 Original policy
L5999Lower limb prosthetics, such as microprocessor- controlled lower limb prostheticsParticipating provider precertification list for Aetna, Pg 10 Original policy
64553Neurostimulator implantation precertification required effective July 1, 2026Participating provider precertification list for Aetna, Pg 10 Original policy
64555Neurostimulator implantation precertification required effective July 1, 2026Participating provider precertification list for Aetna, Pg 10 Original policy
64561Neurostimulator implantation precertification required effective July 1, 2026Participating provider precertification list for Aetna, Pg 10 Original policy
64568Neurostimulator implantation precertification required effective July 1, 2026Participating provider precertification list for Aetna, Pg 10 Original policy
64569Neurostimulator implantation precertification required effective July 1, 2026Participating provider precertification list for Aetna, Pg 10 Original policy
64575Neurostimulator implantation precertification required effective July 1, 2026Participating provider precertification list for Aetna, Pg 10 Original policy
64580Neurostimulator implantation precertification required effective July 1, 2026Participating provider precertification list for Aetna, Pg 10 Original policy
64581Neurostimulator implantation precertification required effective July 1, 2026Participating provider precertification list for Aetna, Pg 10 Original policy
64582Neurostimulator implantation precertification required effective July 1, 2026Participating provider precertification list for Aetna, Pg 10 Original policy
64583Neurostimulator implantation precertification required effective July 1, 2026Participating provider precertification list for Aetna, Pg 10 Original policy
64584Neurostimulator implantation precertification required effective July 1, 2026Participating provider precertification list for Aetna, Pg 10 Original policy
64585Neurostimulator implantation precertification required effective July 1, 2026Participating provider precertification list for Aetna, Pg 10 Original policy
64590Neurostimulator implantation precertification required effective July 1, 2026Participating provider precertification list for Aetna, Pg 10 Original policy
64595Neurostimulator implantation precertification required effective July 1, 2026Participating provider precertification list for Aetna, Pg 10 Original policy
C8007Neurostimulator implantation precertification required effective July 1, 2026Participating provider precertification list for Aetna, Pg 10 Original policy
C8008Neurostimulator implantation precertification required effective July 1, 2026Participating provider precertification list for Aetna, Pg 10 Original policy
C8009Neurostimulator implantation precertification required effective July 1, 2026Participating provider precertification list for Aetna, Pg 10 Original policy
C8011Neurostimulator implantation precertification required effective July 1, 2026Participating provider precertification list for Aetna, Pg 10 Original policy
C8012Neurostimulator implantation precertification required effective July 1, 2026Participating provider precertification list for Aetna, Pg 10 Original policy
C8013Neurostimulator implantation precertification required effective July 1, 2026Participating provider precertification list for Aetna, Pg 10 Original policy
21010Orthognathic surgery procedures, bone grafts, osteotomies and surgical management of the temporomandibular jointParticipating provider precertification list for Aetna, Pg 10 Original policy
21050Orthognathic surgery procedures, bone grafts, osteotomies and surgical management of the temporomandibular jointParticipating provider precertification list for Aetna, Pg 10 Original policy
21060Orthognathic surgery procedures, bone grafts, osteotomies and surgical management of the temporomandibular jointParticipating provider precertification list for Aetna, Pg 10 Original policy
21070Orthognathic surgery procedures, bone grafts, osteotomies and surgical management of the temporomandibular jointParticipating provider precertification list for Aetna, Pg 10 Original policy
21073Orthognathic surgery procedures, bone grafts, osteotomies and surgical management of the temporomandibular jointParticipating provider precertification list for Aetna, Pg 10 Original policy
21120Orthognathic surgery procedures, bone grafts, osteotomies and surgical management of the temporomandibular jointParticipating provider precertification list for Aetna, Pg 10 Original policy
21121Orthognathic surgery procedures, bone grafts, osteotomies and surgical management of the temporomandibular jointParticipating provider precertification list for Aetna, Pg 10 Original policy
21122Orthognathic surgery procedures, bone grafts, osteotomies and surgical management of the temporomandibular jointParticipating provider precertification list for Aetna, Pg 10 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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