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See our precertification lists or utilize our CPT code lookup to see whether a procedure or service requires prior approval. Discover the Aetna difference.
Participating Providers: To determine if prior authorization (PA) is required, enter up to six Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) codes or a CPT group and select SEARCH.
With our user-friendly Aetna CPT Code lookup tool, healthcare professionals can quickly and easily search for specific codes, whether it be a keyword, code number, or description. This streamlines the code lookup process, saving valuable time and improving billing accuracy.
See Evidence of Coverage for a complete description of plan benefits, exclusions, limitations, and conditions of coverage. Plan features and availability may vary by service area. Y0001_0001_22192_2021_C. ©2020 Aetna Inc.
To get prior authorization, your doctor must first submit a request for a specific procedure, test or prescription. They will look at your overall health or any chronic conditions to make that decision. Then they’ll share the request with Aetna.
Codify by AAPC helps you quickly and accurately select the CPT® codes you need to keep your claims on track. With Codify by AAPC cross-reference tools, you can check common code pairings. You also get CPT to ICD-10-CM , CPT to HCPCS , and CPT to Modifier crosswalks.
Our provider cost estimator tool helps your office estimate how much your patients will owe for an office visit or procedure. And it approximates how much Aetna will pay for services. Plus, you can use it prior to a patient's scheduled appointment or procedure.
Find HCPCS codes. Search through the 2024 Healthcare Common Procedure Coding System.
Precertification applies to: Procedures and services on the Aetna Participating Provider Precertification List. Procedures and services on the Aetna Behavioral Health Precertification List. Procedures and services that require precertification under the terms of a member’s plan.
Our NCCI tool provides steps you can take to prevent these NCCI denials: First, know if NCCI edits apply to the services you are submitting. Search for coding pairs by entering your major procedure code. The search results show coding pair lists entitled Column I or Column II.