Aetna Prior Authorization Lookup
Latest Aetna prior authorization updates25
- Prior AuthClinical/Medical PolicyEff. 2025-07-01Aetna Commercial Clinical Program Summary — Medical‑Benefit Drug List and Coverage GuidanceLists medications covered under Aetna's commercial medical benefit with associated therapeutic class, HCPCS codes, precertification requirement, preferred alternatives, and site-of-care indicators; intended for providers submitting or requesting coverage for infused/injected and other medical-benefit drugs.All Aetna updates
- Prior AuthAdministrative/Operational PolicyEff. 2025-01-31Outpatient Behavioral Health Precertification/Preauthorization Nonparticipating Provider Request formGoverns use and submission of the Aetna Outpatient Behavioral Health nonparticipating provider request form for precertification/preauthorization of services; affects nonparticipating providers and requesting providers submitting on behalf of Aetna members (including Medicare and commercial plans) in applicable markets.All Aetna updates
- Prior AuthClinical/Medical PolicyEff. 2025-01-31Transcranial Magnetic Stimulation (TMS) Precertification Information RequestAetna's outpatient behavioral health precertification information request form used to initiate clinical review for TMS for Aetna Medicare Advantage and certain managed plans; it specifies required documentation, submission methods, and clinical details providers must supply.All Aetna updates
- Prior AuthClinical/Medical PolicyEff. 2025-01-01Medicare Part B preferred drug list (MAPD only)Lists medically administered Part B drugs with preferred and non-preferred products and notes when step therapy or prior authorization applies for Aetna Medicare Advantage plans that include prescription drug coverage (MAPD). Affects providers prescribing/administering Part B drugs for Aetna MAPD members.All Aetna updates
- Prior AuthClinical/Medical PolicyEff. 2025-01-01Medicare Part B preferred drug list (MAPD only) — preferred and non-preferred medically administered Part B drugsPreferred and non-preferred medically administered Part B drugs for Aetna Medicare Advantage plans that offer prescription drug coverage (MAPD). Defines preferred products, HCPCS codes, step therapy and prior authorization expectations for multiple drug categories and indications.All Aetna updates
- Prior AuthClinical/Medical PolicyEff. 2025-01-01Medicare Part B preferred drug list (MAPD)Lists preferred and non-preferred medically administered Part B drugs and notes step therapy and prior authorization practices for Aetna Medicare Advantage plans that offer prescription drug coverage (MAPD). Affects providers prescribing/administering Part B drugs to affected members.All Aetna updates
- Prior AuthClinical/Medical PolicyEff. 2025-01-01Medicare Part B preferred drug list — Aetna Medicare Advantage (MA) only plansAetna's Medicare Advantage (MA) Part B preferred drug list describing preferred and non-preferred medically administered (Part B) drugs, applicable utilization management (e.g., step therapy, prior authorization) and HCPCS codes for providers and administrators.All Aetna updates
- Prior AuthClinical/Medical PolicyEff. 2025-01-01Medicare Part B preferred drug list — Aetna Medicare Advantage (MA) only plansLists preferred and non-preferred medically administered Part B drugs by therapeutic category for Aetna Medicare Advantage plans and describes that some drugs are subject to step therapy, prior authorization, or other limits. Affects providers ordering/administering Medicare Part B drugs for Aetna MA members.All Aetna updates
- Prior AuthClinical/Medical PolicyEff. 2025-01-01Preferred drug list for Aetna Medicare Advantage with drug coverage plans (PDF)Aetna Medicare Advantage plans that offer Part B drug coverage: lists drug categories, preferred and non-preferred medically administered (Part B) drugs, associated HCPCS/J-codes, and notes on step therapy, medical necessity, and prior authorization requirements. This is part 1 of 3 and contains multiple categories and drugs with their codes and brief coverage/PA notes or links to criteria.All Aetna updates
- Prior AuthClinical/Medical PolicyEff. 2023-06-01Outpatient Behavioral Health Request — Transcranial Magnetic Stimulation Precertification Information RequestThis document is Aetna's outpatient behavioral health precertification information request form for Transcranial Magnetic Stimulation (TMS), describing required provider submissions and how Aetna will review requests for applicable commercial, Medicare Advantage, and certain delegated plans.All Aetna updates
- Prior AuthClinical/Medical PolicyEff. 2009-08-21Human Fibrinogen Concentrate (RiaSTAP and Fibryga)Defines Aetna's medical necessity, precertification, approved indications, dosing guidance, and excluded indications for human fibrinogen concentrates RiaSTAP and Fibryga for commercial medical plans.All Aetna updates
- Prior AuthClinical/Medical PolicyEff. 2009-07-10Golimumab (Simponi and Simponi Aria) coverageMedical necessity and utilization management criteria for intravenous (Simponi Aria) and subcutaneous (Simponi) golimumab for Aetna commercial medical plans, including prescriber requirements, indications, continuation criteria, dosing notes, and precertification/site-of-care rules.All Aetna updates
- Prior AuthClinical/Medical PolicyEff. 2009-04-10Hereditary AngioedemaDefines Aetna's medical necessity, precertification, and coverage criteria for prophylactic and acute pharmacologic treatments for hereditary angioedema (HAE) for commercial medical plans and specifies site-of-care considerations for certain agents.All Aetna updates
- Prior AuthClinical/Medical PolicyEff. 2009-03-20Robotic-assisted Rehabilitation of the ExtremitiesThis policy governs Aetna's coverage stance for robotic-assisted rehabilitation interventions and devices for upper and lower extremities, specifying which indications and devices are considered experimental/investigational and noting related policy cross-references. It affects providers submitting claims and prior authorization requests to Aetna.All Aetna updates
- Prior AuthClinical/Medical PolicyEff. 2008-08-08Certolizumab Pegol (Cimzia)Defines Aetna commercial medical plan precertification, prescribing, and medical necessity criteria for certolizumab pegol (Cimzia) for rheumatologic, dermatologic, and gastroenterologic indications and continuation of therapy.All Aetna updates
- Prior AuthClinical/Medical PolicyEff. 2008-08-08Repository Corticotropin Injection (Acthar Gel and Purified Cortrophin Gel)Defines Aetna's coverage stance, precertification and clinical criteria for repository corticotropin injections (Acthar Gel and Purified Cortrophin Gel) for commercial medical plans, including FDA‑approved infantile spasms indication and other indications considered not medically necessary or experimental.All Aetna updates
- Prior AuthClinical/Medical PolicyEff. 2008-04-11NatalizumabClinical coverage and utilization management criteria for natalizumab (Tysabri and biosimilar Tyruko) for Crohn's disease and relapsing forms of multiple sclerosis, including precertification and site-of-care notes, for Aetna commercial medical plans.All Aetna updates
- Prior AuthClinical/Medical PolicyEff. 2008-03-07Panitumumab (Vectibix)This policy governs medical necessity, precertification, and coverage criteria for panitumumab (Vectibix) in commercial Aetna medical plans, primarily addressing use in colorectal cancer and related testing requirements.All Aetna updates
- Prior AuthClinical/Medical PolicyEff. 2006-06-20Post-Herpetic NeuralgiaDefines Aetna's medical necessity and experimental/investigational determinations for therapies, procedures, and codes related to diagnosis and treatment of post-herpetic neuralgia (PHN); applies to Aetna members and providers submitting claims or prior authorization requests.All Aetna updates
- Prior AuthClinical/Medical PolicyEff. 2006-03-17Abatacept (Orencia)Defines Aetna's medical necessity, precertification, prescribing specialty, and dosing/coding guidance for abatacept (Orencia) for commercial medical plans, including initial and continuation criteria for RA, JIA, PsA, graft-versus-host disease prophylaxis/treatment, and immune checkpoint inhibitor‑related toxicity.All Aetna updates
- Prior AuthClinical/Medical PolicyEff. 2005-03-15Vascular Endothelial Growth Factor Inhibitors for Ocular IndicationsThis policy governs medical necessity, precertification, and coverage criteria for vascular endothelial growth factor (VEGF) inhibitor injections for ocular indications under Aetna commercial medical plans, and identifies required prescriber specialties and continuation criteria.All Aetna updates
- Prior AuthClinical/Medical PolicyEff. 2005-03-15Vascular Endothelial Growth Factor Inhibitors for Ocular IndicationsThis policy governs medical necessity, precertification, indications, continuation criteria, and dosing guidance for vascular endothelial growth factor (VEGF) inhibitors used for ocular conditions for Aetna commercial medical plans.All Aetna updates
- Prior AuthClinical/Medical PolicyEff. 2004-12-07Somatostatin AnalogsPolicy governing medical necessity, precertification, indications, continuation criteria, and dosing guidance for somatostatin analog injections for Aetna commercial medical plans.All Aetna updates
- Prior AuthClinical/Medical PolicyEff. 2004-05-14Bevacizumab for Non-Ocular IndicationsDefines Aetna's medical necessity, precertification, covered and experimental indications, dosage guidance, and billing codes for bevacizumab and its biosimilars for non-ocular oncology uses for Aetna commercial medical plans.All Aetna updates
- Prior AuthClinical/Medical PolicyEff. 2004-04-13Cetuximab (Erbitux)Defines Aetna's medical necessity, precertification, and coverage criteria for cetuximab (Erbitux) for commercial medical plans, including approved disease indications, continuation criteria, and investigational uses.All Aetna updates
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Tool Description
Search Aetnaprior authorization policies by drug name, procedure, or policy title. Results include any policy that mentions prior authorization requirements (drug coverage criteria, imaging guidelines, site-of-service rules) not just documents titled “prior authorization.” Every result links to a full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
Filter by payer, specialty, policy type, or effective year; or search directly for a drug (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee arthroplasty”), or a policy number.
Coverage spans 110+ payers. Jump straight to the busiest prior-auth publishers: UnitedHealthcare, Cigna, Aetna, Anthem, and Centene. You can also browse the full policy updates feed.
Pair a prior-auth search with the billing code lookup to confirm the CPT or J-code on the claim, the payer lookup for plan footprint, and payer profiles for contacts and coverage context.
FAQ
Type a drug name (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee”), or a policy title into the search bar. Filter results by payer, specialty, policy type, or effective year. Open any result for the full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
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