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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.
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. PA requirement results are valid as of today’s date only.
View the lists or input your procedure code(s) into the tool to see if we require precertification. Request referral for consultation services and treatment with specialists. You can submit requests electronically. Just use our provider portal on Availity®. Or find a vendor from our list — vendor fees may apply.
Our Aetna CPT Code lookup tool simplifies the billing process by providing a quick and easy way to search for specific codes. Whether you’re searching for a particular CPT code or need to find codes for a specific medical procedure, our tool allows you to search by keyword, code number, or description.
For more information, read all general precertification guidelines. Providers may submit most precertification requests electronically through the secure provider website or using your Electronic Medical Record (EMR) system portal. See #1 in the General Information section for more information on precertification.
37253. Aetna® is partnering with EviCore to provide their members with access to specific procedures for Peripheral Vascular Disease. Effective for dates of service 9/1/23 and beyond, certain Vascular Intervention procedures will require prior authorization for Aetna Medicare, Commercial Fully-Insured, and Individual & Family (IFP) Plans.
You can find out if a specific procedure requires precertification using our Precertification Code Search Tool.1. The tool is available at www.aetna.com. Under “Quick Links,” select “Check Precertification List.” The Precertification Code Search Tool: Allows you to enter a valid five-digit CPT or HCPCS code.
You can find a current list of the services that need PA on the Provider Portal. You can also find out if a service needs PA by using ProPAT, our online prior authorization search tool. Search ProPAT.
Prior authorization (PA) is required for acute outpatient services and planned hospital admissions. We don’t require PA for emergency care. You can find out if a service needs PA by using ProPAT, our online prior authorization search tool. Search ProPAT.
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.