Talk to Us

Aetna prior authorization and CPT code lookup, page 7

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
21123Orthognathic surgery procedures, bone grafts, osteotomies and surgical management of the temporomandibular jointParticipating provider precertification list for Aetna, Pg 10 Original policy
21125Orthognathic surgery procedures, bone grafts, osteotomies and surgical management of the temporomandibular jointParticipating provider precertification list for Aetna, Pg 10 Original policy
21127Orthognathic surgery procedures, bone grafts, osteotomies and surgical management of the temporomandibular jointParticipating provider precertification list for Aetna, Pg 10 Original policy
21141Orthognathic surgery procedures, bone grafts, osteotomies and surgical management of the temporomandibular jointParticipating provider precertification list for Aetna, Pg 10 Original policy
21142Orthognathic surgery procedures, bone grafts, osteotomies and surgical management of the temporomandibular jointParticipating provider precertification list for Aetna, Pg 10 Original policy
21143Orthognathic surgery procedures, bone grafts, osteotomies and surgical management of the temporomandibular jointParticipating provider precertification list for Aetna, Pg 10 Original policy
21145Orthognathic surgery procedures, bone grafts, osteotomies and surgical management of the temporomandibular jointParticipating provider precertification list for Aetna, Pg 10 Original policy
21146Orthognathic surgery procedures, bone grafts, osteotomies and surgical management of the temporomandibular jointParticipating provider precertification list for Aetna, Pg 10 Original policy
21147Orthognathic surgery procedures, bone grafts, osteotomies and surgical management of the temporomandibular jointParticipating provider precertification list for Aetna, Pg 10 Original policy
21150Orthognathic surgery procedures, bone grafts, osteotomies and surgical management of the temporomandibular jointParticipating provider precertification list for Aetna, Pg 10 Original policy
21151Orthognathic surgery procedures, bone grafts, osteotomies and surgical management of the temporomandibular jointParticipating provider precertification list for Aetna, Pg 10 Original policy
21154Orthognathic surgery procedures, bone grafts, osteotomies and surgical management of the temporomandibular jointParticipating provider precertification list for Aetna, Pg 10 Original policy
21159Orthognathic surgery procedures, bone grafts, osteotomies and surgical management of the temporomandibular jointParticipating provider precertification list for Aetna, Pg 10 Original policy
21193Orthognathic surgery procedures, bone grafts, osteotomies and surgical management of the temporomandibular jointParticipating provider precertification list for Aetna, Pg 10 Original policy
21194Orthognathic surgery procedures, bone grafts, osteotomies and surgical management of the temporomandibular jointParticipating provider precertification list for Aetna, Pg 10 Original policy
21195Orthognathic surgery procedures, bone grafts, osteotomies and surgical management of the temporomandibular jointParticipating provider precertification list for Aetna, Pg 10 Original policy
21196Orthognathic surgery procedures, bone grafts, osteotomies and surgical management of the temporomandibular jointParticipating provider precertification list for Aetna, Pg 10 Original policy
21198Orthognathic surgery procedures, bone grafts, osteotomies and surgical management of the temporomandibular jointParticipating provider precertification list for Aetna, Pg 10 Original policy
21199Orthognathic surgery procedures, bone grafts, osteotomies and surgical management of the temporomandibular jointParticipating provider precertification list for Aetna, Pg 10 Original policy
21206Orthognathic surgery procedures, bone grafts, osteotomies and surgical management of the temporomandibular jointParticipating provider precertification list for Aetna, Pg 10 Original policy
21208Orthognathic surgery procedures, bone grafts, osteotomies and surgical management of the temporomandibular jointParticipating provider precertification list for Aetna, Pg 10 Original policy
21209Orthognathic surgery procedures, bone grafts, osteotomies and surgical management of the temporomandibular jointParticipating provider precertification list for Aetna, Pg 10 Original policy
21210Orthognathic surgery procedures, bone grafts, osteotomies and surgical management of the temporomandibular jointParticipating provider precertification list for Aetna, Pg 10 Original policy
21215Orthognathic surgery procedures, bone grafts, osteotomies and surgical management of the temporomandibular jointParticipating provider precertification list for Aetna, Pg 10 Original policy
21240Orthognathic surgery procedures, bone grafts, osteotomies and surgical management of the temporomandibular jointParticipating provider precertification list for Aetna, Pg 10 Original policy
21242Orthognathic surgery procedures, bone grafts, osteotomies and surgical management of the temporomandibular jointParticipating provider precertification list for Aetna, Pg 10 Original policy
21243Orthognathic surgery procedures, bone grafts, osteotomies and surgical management of the temporomandibular jointParticipating provider precertification list for Aetna, Pg 10 Original policy
21244Orthognathic surgery procedures, bone grafts, osteotomies and surgical management of the temporomandibular jointParticipating provider precertification list for Aetna, Pg 10 Original policy
21247Orthognathic surgery procedures, bone grafts, osteotomies and surgical management of the temporomandibular jointParticipating provider precertification list for Aetna, Pg 10 Original policy
21255Orthognathic surgery procedures, bone grafts, osteotomies and surgical management of the temporomandibular jointParticipating provider precertification list for Aetna, Pg 10 Original policy
21480Orthognathic surgery procedures, bone grafts, osteotomies and surgical management of the temporomandibular jointParticipating provider precertification list for Aetna, Pg 10 Original policy
21485Orthognathic surgery procedures, bone grafts, osteotomies and surgical management of the temporomandibular jointParticipating provider precertification list for Aetna, Pg 10 Original policy
21490Orthognathic surgery procedures, bone grafts, osteotomies and surgical management of the temporomandibular jointParticipating provider precertification list for Aetna, Pg 10 Original policy
21497Orthognathic surgery procedures, bone grafts, osteotomies and surgical management of the temporomandibular jointParticipating provider precertification list for Aetna, Pg 10 Original policy
29800Orthognathic surgery procedures, bone grafts, osteotomies and surgical management of the temporomandibular jointParticipating provider precertification list for Aetna, Pg 10 Original policy
29804Orthognathic surgery procedures, bone grafts, osteotomies and surgical management of the temporomandibular jointParticipating provider precertification list for Aetna, Pg 10 Original policy
69714Osseointegrated implant*Participating provider precertification list for Aetna, Pg 10 Original policy
69716Osseointegrated implant*Participating provider precertification list for Aetna, Pg 10 Original policy
L8690Osseointegrated implant*Participating provider precertification list for Aetna, Pg 10 Original policy
L8691Osseointegrated implant*Participating provider precertification list for Aetna, Pg 10 Original policy
L8692Osseointegrated implant*Participating provider precertification list for Aetna, Pg 10 Original policy
L8693Osseointegrated implant*Participating provider precertification list for Aetna, Pg 10 Original policy
S9123Private duty nursingParticipating provider precertification list for Aetna, Pg 11 Original policy
S9124Private duty nursingParticipating provider precertification list for Aetna, Pg 11 Original policy
T1000Private duty nursingParticipating provider precertification list for Aetna, Pg 11 Original policy
T1030Private duty nursingParticipating provider precertification list for Aetna, Pg 11 Original policy
T1031Private duty nursingParticipating provider precertification list for Aetna, Pg 11 Original policy
55880Prostate surgery High intensity-focused ultrasound (HIFU)Participating provider precertification list for Aetna, Pg 11 Original policy
77520Proton beam radiotherapy Also see Special programs: Radiation oncologyParticipating provider precertification list for Aetna, Pg 11 Original policy
77522Proton beam radiotherapy Also see Special programs: Radiation oncologyParticipating provider precertification list for Aetna, Pg 11 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.

This website uses cookies to ensure you get the best experience on our website. Learn more