Aetna prior authorization and CPT code lookup, page 9
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 |
|---|---|---|
| 43645 | Reconstructive or other procedures that may be considered cosmetic: Gastroplasty/gastric bypass | Participating provider precertification list for Aetna, Pg 11 Original policy |
| 43659 | Reconstructive or other procedures that may be considered cosmetic: Gastroplasty/gastric bypass | Participating provider precertification list for Aetna, Pg 11 Original policy |
| 43770 | Reconstructive or other procedures that may be considered cosmetic: Gastroplasty/gastric bypass | Participating provider precertification list for Aetna, Pg 11 Original policy |
| 43771 | Reconstructive or other procedures that may be considered cosmetic: Gastroplasty/gastric bypass | Participating provider precertification list for Aetna, Pg 11 Original policy |
| 43772 | Reconstructive or other procedures that may be considered cosmetic: Gastroplasty/gastric bypass | Participating provider precertification list for Aetna, Pg 11 Original policy |
| 43773 | Reconstructive or other procedures that may be considered cosmetic: Gastroplasty/gastric bypass | Participating provider precertification list for Aetna, Pg 11 Original policy |
| 43774 | Reconstructive or other procedures that may be considered cosmetic: Gastroplasty/gastric bypass | Participating provider precertification list for Aetna, Pg 11 Original policy |
| 43775 | Reconstructive or other procedures that may be considered cosmetic: Gastroplasty/gastric bypass | Participating provider precertification list for Aetna, Pg 11 Original policy |
| 43842 | Reconstructive or other procedures that may be considered cosmetic: Gastroplasty/gastric bypass | Participating provider precertification list for Aetna, Pg 11 Original policy |
| 43843 | Reconstructive or other procedures that may be considered cosmetic: Gastroplasty/gastric bypass | Participating provider precertification list for Aetna, Pg 11 Original policy |
| 43845 | Reconstructive or other procedures that may be considered cosmetic: Gastroplasty/gastric bypass | Participating provider precertification list for Aetna, Pg 11 Original policy |
| 43846 | Reconstructive or other procedures that may be considered cosmetic: Gastroplasty/gastric bypass | Participating provider precertification list for Aetna, Pg 11 Original policy |
| 43847 | Reconstructive or other procedures that may be considered cosmetic: Gastroplasty/gastric bypass | Participating provider precertification list for Aetna, Pg 11 Original policy |
| 43848 | Reconstructive or other procedures that may be considered cosmetic: Gastroplasty/gastric bypass | Participating provider precertification list for Aetna, Pg 11 Original policy |
| 43886 | Reconstructive or other procedures that may be considered cosmetic: Gastroplasty/gastric bypass | Participating provider precertification list for Aetna, Pg 11 Original policy |
| 43887 | Reconstructive or other procedures that may be considered cosmetic: Gastroplasty/gastric bypass | Participating provider precertification list for Aetna, Pg 11 Original policy |
| 43888 | Reconstructive or other procedures that may be considered cosmetic: Gastroplasty/gastric bypass | Participating provider precertification list for Aetna, Pg 11 Original policy |
| 43999 | Reconstructive or other procedures that may be considered cosmetic: Gastroplasty/gastric bypass | Participating provider precertification list for Aetna, Pg 11 Original policy |
| 49999 | Reconstructive or other procedures that may be considered cosmetic: Gastroplasty/gastric bypass | Participating provider precertification list for Aetna, Pg 11 Original policy |
| 15876 | Reconstructive or other procedures that may be considered cosmetic: Lipectomy or excess fat removal* | Participating provider precertification list for Aetna, Pg 11 Original policy |
| 15877 | Reconstructive or other procedures that may be considered cosmetic: Lipectomy or excess fat removal* | Participating provider precertification list for Aetna, Pg 11 Original policy |
| 15878 | Reconstructive or other procedures that may be considered cosmetic: Lipectomy or excess fat removal* | Participating provider precertification list for Aetna, Pg 11 Original policy |
| 15879* | Reconstructive or other procedures that may be considered cosmetic: Lipectomy or excess fat removal* | Participating provider precertification list for Aetna, Pg 11 Original policy |
| 36482 | Reconstructive or other procedures that may be considered cosmetic (continued): Surgery for varicose veins, except stab phlebectomy* Precertification required | Participating provider precertification list for Aetna, Pg 12 Original policy |
| 36483 | Reconstructive or other procedures that may be considered cosmetic (continued): Surgery for varicose veins, except stab phlebectomy* Precertification required | Participating provider precertification list for Aetna, Pg 12 Original policy |
| 36475 | Reconstructive or other procedures that may be considered cosmetic (continued): Surgery for varicose veins, except stab phlebectomy* effective August 1, 2026 | Participating provider precertification list for Aetna, Pg 12 Original policy |
| 36476 | Reconstructive or other procedures that may be considered cosmetic (continued): Surgery for varicose veins, except stab phlebectomy* effective August 1, 2026 | Participating provider precertification list for Aetna, Pg 12 Original policy |
| 36478 | Reconstructive or other procedures that may be considered cosmetic (continued): Surgery for varicose veins, except stab phlebectomy* effective August 1, 2026 | Participating provider precertification list for Aetna, Pg 12 Original policy |
| 36479 | Reconstructive or other procedures that may be considered cosmetic (continued): Surgery for varicose veins, except stab phlebectomy* effective August 1, 2026 | Participating provider precertification list for Aetna, Pg 12 Original policy |
| 37700 | Reconstructive or other procedures that may be considered cosmetic (continued): Surgery for varicose veins, except stab phlebectomy* effective August 1, 2026 | Participating provider precertification list for Aetna, Pg 12 Original policy |
| 37718 | Reconstructive or other procedures that may be considered cosmetic (continued): Surgery for varicose veins, except stab phlebectomy* effective August 1, 2026 | Participating provider precertification list for Aetna, Pg 12 Original policy |
| 37722 | Reconstructive or other procedures that may be considered cosmetic (continued): Surgery for varicose veins, except stab phlebectomy* effective August 1, 2026 | Participating provider precertification list for Aetna, Pg 12 Original policy |
| 37735 | Reconstructive or other procedures that may be considered cosmetic (continued): Surgery for varicose veins, except stab phlebectomy* effective August 1, 2026 | Participating provider precertification list for Aetna, Pg 12 Original policy |
| 37760 | Reconstructive or other procedures that may be considered cosmetic (continued): Surgery for varicose veins, except stab phlebectomy* effective August 1, 2026 | Participating provider precertification list for Aetna, Pg 12 Original policy |
| 37761 | Reconstructive or other procedures that may be considered cosmetic (continued): Surgery for varicose veins, except stab phlebectomy* effective August 1, 2026 | Participating provider precertification list for Aetna, Pg 12 Original policy |
| 37780 | Reconstructive or other procedures that may be considered cosmetic (continued): Surgery for varicose veins, except stab phlebectomy* effective August 1, 2026 | Participating provider precertification list for Aetna, Pg 12 Original policy |
| 37785 | Reconstructive or other procedures that may be considered cosmetic (continued): Surgery for varicose veins, except stab phlebectomy* effective August 1, 2026 | Participating provider precertification list for Aetna, Pg 12 Original policy |
| 0524T | Reconstructive or other procedures that may be considered cosmetic (continued): Surgery for varicose veins, except stab phlebectomy* effective August 1, 2026 | Participating provider precertification list for Aetna, Pg 12 Original policy |
| 22856 | Spinal procedures: Artificial intervertebral disc surgery (cervical spine) | Participating provider precertification list for Aetna, Pg 13 Original policy |
| 22858 | Spinal procedures: Artificial intervertebral disc surgery (cervical spine) | Participating provider precertification list for Aetna, Pg 13 Original policy |
| 22861 | Spinal procedures: Artificial intervertebral disc surgery (cervical spine) | Participating provider precertification list for Aetna, Pg 13 Original policy |
| 22857 | Spinal procedures: Artificial intervertebral disc surgery (lumbar spine) | Participating provider precertification list for Aetna, Pg 13 Original policy |
| 22860 | Spinal procedures: Artificial intervertebral disc surgery (lumbar spine) | Participating provider precertification list for Aetna, Pg 13 Original policy |
| 22862 | Spinal procedures: Artificial intervertebral disc surgery (lumbar spine) | Participating provider precertification list for Aetna, Pg 13 Original policy |
| 22865 | Spinal procedures: Artificial intervertebral disc surgery (lumbar spine) | Participating provider precertification list for Aetna, Pg 13 Original policy |
| 63050 | Spinal procedures: Cervical laminoplasty* | Participating provider precertification list for Aetna, Pg 13 Original policy |
| 63051 | Spinal procedures: Cervical laminoplasty* | Participating provider precertification list for Aetna, Pg 13 Original policy |
| 63001 | Spinal procedures: Cervical, lumbar and thoracic laminectomy and/or laminotomy procedures* | Participating provider precertification list for Aetna, Pg 13 Original policy |
| 63003 | Spinal procedures: Cervical, lumbar and thoracic laminectomy and/or laminotomy procedures* | Participating provider precertification list for Aetna, Pg 13 Original policy |
| 63005 | Spinal procedures: Cervical, lumbar and thoracic laminectomy and/or laminotomy procedures* | Participating provider precertification list for Aetna, Pg 13 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.