Cpt code lookup aetna. No Longer Requiring Precertification (Effective March 1, 2025) BRCA Genetic Testing (CPT® Code 81433) Evrysdi® (risdiplam) – J8499 Require Precertification Effective March 14, 2025 Ziihera® (zanidatamab-hrii, J3490, J3590 Any use of CPT outside of Aetna Precertification Code Search Tool should refer to the most Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. Exceptions: See Evidence of Coverage for a complete description of plan benefits, exclusions, limitations, and conditions of coverage. Additional information including the fee schedule can be found here. They are based on objective, credible sources, such as the scientific literature, guidelines, consensus statements and expert opinions. Subcontractors Aetna Better Health of Ohio works with certain subcontractors to coordinate services that are provided by entities other than the health plan, such as transportation, vision or dental services. Providers using this tool can: Jan 31, 2025 · Explore the latest telehealth billing codes for 2025, including Medicare, Aetna policies, and Modifier 93. NCCA member, Liz Nieland, has compiled general CPT Codes that are billable for chiropractic offices for easy reference. Review the Provider Manual 2025 for detailed billing and documentation guidance. Explore a variety of Medicare resources for health care professionals and providers. Updated September 1, 2025 This document is a quick guide for your ofice to use for precertification with patients enrolled in Aetna health plans. , Suite 39300, Chicago, IL 60611-5885. and its territories. Future changes to CPT or Healthcare Common Procedure Coding System (HCPCS) codes that require PA will be communicated by Aetna Better Health in writing and on the home page of Aetna Better Health's secure web portal. Aetna Better Health ® of Illinois requires prior authorization for select acute outpatient services and planned hospital admissions, but not for emergency services. Search results are not a guarantee of claim payment. Learn how to use our online precertification tools. Note: Precertification may be required for select procedures and interventions. Find out if your prescription drug is covered by your 2025 Advanced Control Plan. At a national level, CMS identifies individual services that are components of more inclusive services using NCCI edits. As always, don't hesitate to contact your Aetna Provider Experience Representative with any questions, comments or if you’d like to review Aetna’s provider notices, please visit our Aetna website:. Use our online tools and resources to manage your health. This manual applies to any health care provider, including physicians, health care professionals, behavioral health providers, hospitals, facilities, and ancillary providers, who contract with Aetna directly or indirectly, except when indicated otherwise. Avastin (bevacizumab), Avzivi (bevacizumab-tnjn), Vegzelma (bevacizumab-adcd), and Updated September 1, 2025 This document is a quick guide for your ofice to use for precertification with patients enrolled in Aetna health plans. The five-character codes included in the Aetna Better Health of Texas PA Requirement Search Tool are obtained from Current Procedural Terminology (CPT), by the American Medical Association (AMA). Find articles on fitness, diet, nutrition, health news headlines, medicine, diseases Prior authorization is required for some in-network care and all out-of-network care. Log in or register. Aug 1, 2024 · You can use this document as an overview of best practices working with Aetna. You acknowledge that AMA holds all copyright, trademark and other rights in CPT. Aetna Better Health® of Florida Current Procedural Terminology (CPT®) Coding Incentive Program for Providers Aetna Better Health® of Florida providers will have the opportunity to earn an additional $25 by adding specific CPT® codes to their claims. It will be your reference for Current Procedural Terminology (CPT®) codes for services, programs and prescriptions that require approval for coverage. *Availity is available only to U. The codes also simplify how performance measures are reported and reduce the need for chart abstraction. Navigate Aetna CPT code lookup easily for accurate medical billing. Search results, as well as authorizations are not a guarantee of claim payment. Increasing the use of substance use screenings can help patients who may be at risk for addiction or other substance use disorders (SUD). So, when you have questions, we’ve got answers! Our Customer Support team is just a phone call away for guidance on COVID-19 information, precertification and all your inquiries. You'll need to know your Aetna® provider ID number (PIN) to access our Code Edit Lookup tools. 1 day ago · You, your employees and agents are authorized to use CPT only as contained in Aetna Precertification Code Search Tool solely for your own personal use in directly participating in health care programs administered by Aetna, Inc. How to Search a CPT or HCPCS Code(s) in Propat & determine if PA Authorization is required? Step 1 – Enter CPT or HCPCS Code (s). S. e. A current list of the services that require authorization is available on ProPAT, our online prior authorization search tool. Providers can use these codes to Nov 1, 2022 · Check out the table of contents on the next page for a closer look at what you’ll find in this guide. Support when you need it Your online Meritain Health provider portal gives you instant, online access to patient eligibility, claims information, forms and more. Learn about Aetna Medicare Advantage plans and find information about Part D prescription drug coverage, Medicare coverage determinations, disputes and appeals, and more. Learn how to request PA here. Learn more at Ambetter from Absolute Total Care. Plan features and availability may vary by service area. You’ll also find resources to help you navigate Aetna functionality on Availity. Wabash Ave. The five-character codes included in the Aetna Medicaid PA Requirement Search Tool are obtained from Current Procedural Terminology (CPT), by the American Medical Association (AMA). Find the codes you need swiftly with our comprehensive search tool. Search ProPAT The input is not a valid Base-64 string as it contains a non-base 64 character, more than two padding characters, or an illegal character among the padding characters. This tool allows you to display, download all fees by state or code and to lookup individual codes. Health care professionals and providers, let’s navigate Medicare together. Start here to choose a topic to support your practice and patients, including compliance and attestation, plan basics and resources, Part B drug coverage and more. 37246 37247 37252 37253 Aetna® is partnering with EviCore to provide their members with access to specific procedures for Peripheral Vascular Disease. Brand Selection for Medically Necessary Indications for Commercial Medical Plans As defined in Aetna commercial policies, health care services are not medically necessary when they are more costly than alternative services that are at least as likely to produce equivalent therapeutic or diagnostic results. Precertification Code Search tool — allows you to enter up to five CPT codes at a time to quickly determine whether a medical precertification is required for your patient. You'll need to know your Aetna® provider ID number (PIN) to access our code edit lookup tools. ProPAT CPT Code Lookup : Aetna Better Health Health (5 days ago) The five character codes included in the Aetna Medicaid PA Requirement Search Tool are obtained from Current Procedural Terminology (CPT), by the American Medical Association … Oct 17, 2024 · License to use CPT for any use not authorized herein must be obtained through the AMA, CPT Intellectual Property Services, AMA Plaza, 330 N. Obstructive Sleep Apnea in Adults Number: 0004 Table Of Contents Policy Applicable CPT / HCPCS / ICD-10 Codes Background References May 31, 2024 · CPT copyright 2024 American Medical Association. ** If you need precertification for a specialty drug for a commercial or Medicare member, submit your request through Novologix®, also available on Availity®. *Availity is available only to providers in the U. Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its afiliates (Aetna). Y0001_0001_22192_2021_C ©2020 Aetna Inc. Medical Necessity Aetna considers endoscopic ultrasonography (EUS) medically necessary for any of the following indications: Diagnosing common bile duct stones; or Evaluating abnormalities of the biliary tree; or Evaluating abnormalities of the gastrointestinal tract wall or adjacent structures; or Need to do a pre-auth check? Use our pre-authorization tool so we can make sure the services and prescriptions provided are medically necessary. Discover the Aetna difference. Future changes to CPT or Healthcare Common Procedure Coding System (HCPCS) codes that require PA will be communicated by Aetna Better Health in writing and on the home page of Aetna Better Health’s secure web portal. The portal allows selection of unlimited CPT and ICD codes. CPT is developed by the AMA as a listing of descriptive terms and five-character identifying codes and modifiers for reporting medical services and procedures performed by physicians. Nov 26, 2024 · We maintain and annually update a List of Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS) Codes (the Code List), which identifies all the items and services included within certain designated health services (DHS) categories or that may qualify for certain exceptions. Looking for a specific procedure? Use our precertification code search tool on aetna. Stay compliant for smooth reimbursement. Case Creation – CPT/ICD Codes Begin typing the CPT and ICD codes or descriptions, then click the appropriate option with your cursor. Aetna may add discover Aetna Better Health Propat Cpt Code. Prior authorization is required for select, acute outpatient services and planned hospital admissions. 1-50 51-100 101-150 151-200 201-250 251-300 301-350 351-400 401-450 451-500 501-550 551-600 601-650 651-700 701-750 751-800 1-50 0001-Transrectal Ultrasound 0002-Oxygen 0003-Apnea Monitors for Infants 0004-Obstructive Sleep Apnea in Adults 0005-Septoplasty and Rhinoplasty 0007-Erectile Dysfunction 0008-Color-Flow Doppler Echocardiography in Adults 0009-Orthopedic Casts, Braces and Splints 0010 Current Procedural Terminology (CPT) II codes are supplemental tracking codes that can be used for performance measurement and to track the delivery of quality of care. As a participating provider you must comply with our policies, many of which are described or linked within this manual. Common CPT codes for Telehealth can be found at our telehealth billing guide. Aetna provides certain management services on behalf of its Aetna Better Health of Illinois Prior Authorization Procedure List: Radiology & Cardiology We will deny certain codes starting on September 1. Are you asking for precertification on a specialty drug for a commercial or Medicare member? Then submit your request through Novologix®, also available on Availity®. Use our “Search by CPT® code” function on our Precertification Lists page to find out if the code requires precertification. Descubra la diferencia que marca Aetna. Find information to help you get ready and stay updated. Aetna Better Health ® of Maryland requires PA for some outpatient care as well as for planned hospital admissions. Future changes to CPT or Healthcare Common Procedure Coding System (HCPCS) codes that require PA will be communicated by Aetna Better Health on the home page of Aetna Better Health’s secure web portal. Current Procedural Terminology (CPT) II codes are supplemental tracking codes that can be used for performance measurement and to track the delivery of quality of care. Sarah Chen Billing Manager CPT Code Authorization Lookup CPT Code Lookup CPT Codes Enter multiple 5-digit CPT codes separated by commas Insurance Information Precertification Lists Aetna Health (4 days ago) See our precertification lists or utilize our CPT code lookup to see whether a procedure or service requires prior approval. 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. Coding and billing tools for ICD-10-CM/PCS, CPT, HCPCS. Mar 1, 2025 · Latest Aetna Update- April 2025 Source – Aetna Important updates to Aetna’s National Precertification List (NPL) that apply to both commercial and medicare members. Prior authorization is required for some out-of-network providers, outpatient care and planned hospital admissions. ** Learn more about precertification. You can use this document as an overview of best practices working with Aetna. ALL inpatient confinements … Policy Scope of Policy This Clinical Policy Bulletin addresses knee arthroplasty. Health care providers, get access to screeners for different age groups, find the CPT codes you need to get reimbursed, and explore helpful resources for you and your patients. The Availity portal is providers’ one-stop shop for doing business with us. Medical Necessity Food and Drug Administration (FDA) approved total knee arthroplasty (TKA) prosthesis is considered medically necessary for adult members when the Best viewed in Microsoft Internet Explorer 6 and higher, resolution 1280x800. Policy Scope of Policy This Clinical Policy Bulletin addresses vasectomy procedures. ALL providers, including ABA providers, must enroll in the DMAS Provider Services Solution (PRSS) and select Aetna Better Health of Virginia. All rights reserved. Dr. You can also look up Core Based Statistical Area (CBSA) codes. First, all inpatient stays require it. , assessing the site and condition of the problem area, explaining the procedure, obtaining informed consent); however, when significant and identifiable (i. Consulte nuestras listas de precertificación o use nuestra búsqueda de códigos de CPT para comprobar si un procedimiento o un servicio requieren aprobación previa. Aetna Resources IMPORTANT UPDATE: The following CPT codes have been removed from the Aetna Vascular Intervention program, effective immediately. Jan 1, 2024 · Use our “Search by CPT code” search function on our precertification lists page to find out if the code requires precertification. Learn about Aetna’s provider cost estimator and physician fee schedule tools to help you estimate patient costs. We may request medical records for certain claims, such as high-dollar claims, implant claims, anesthesia claims, and bundled services claims, to help confirm coding accuracy. As an Aetna Better Health provider, you need to prescribe medically necessary therapy or medications for a member. ProPAT CPT Code Lookup : Aetna Better Health Health (5 days ago) Find out if prior authorization is required for CPT or HCPCS codes by entering them or selecting a group. Medical Clinical Policy Bulletins Dental Clinical Policy Bulletins Pharmacy Clinical Policy Bulletins Clinical Policy Bulletins FAQs Clinical Policy Get tools and guidelines from Aetna to help with submitting insurance claims and collecting payments from patients. This is not a guarantee of payment, payment is conditional upon the participants employment status, plan eligibility, payment of the premium, amount of benefit remaining, plan provisions and plan exclusions. We’ll show you how to look up procedure codes that require preauthorization, submit requests and other key tasks. com/provider. Best viewed in Microsoft Internet Explorer 6 and higher, resolution 1280x800. Get information about Aetna’s precertification requirements, including precertification lists and criteria for patient insurance preauthorization. It allows you to submit claims, get authorizations & referrals, check patient benefits & eligibility, and more. g. Note to Washington State providers: Your effective date for changes described in this article will be communicated following regulatory review. This is part of a larger optimization initiative intended to ensure the safety, medical necessity, and appropriateness of request procedures. We would like to show you a description here but the site won’t allow us. Then, choose “CPT Code Future changes to CPT or Healthcare Common Procedure Coding System (HCPCS) codes that require PA will be communicated by Aetna Better Health in writing and on the home page of Aetna Better Health’s secure web portal. NCCI edits are designed to promote Explore Aetna’s electronic transaction tools available to help you simplify administrative tasks, like electronic patient referrals and e-prescribing. What procedures require precertification? Visit our website to see our precertification list. Visit our ProPAT CPT Code Lookup : Aetna Better Health of Kentucky to confirm which services require approval. Use this guide for precertification (also known as prior authorization or prior approval) with patients enrolled in Gravie health plans. discover Aetna Better Health Codes. Medical Necessity Aetna considers vasectomy reversal medically necessary for the treatment of post-vasectomy pain syndrome if member has failed non-steroidal anti-inflammatory medications and local nerve blocks/steroid injections. We update the Code List to conform to the most recent publications of CPT and HCPCS discover Aetna Better Health Cpt Code Search. Sep 1, 2025 · See our precertification lists or utilize our CPT code lookup to see whether a procedure or service requires prior approval. * If you need precertification for a specialty drug for a commercial or Medicare member, submit your request through Novologix®, also available on Availity**. This process is also known as prior authorization or prior approval. Claim Management on Availity® Jun 17, 2025 · Prior authorization (PA) is required for some out-of-network providers, outpatient care and planned hospital admissions. Participating providers can now check for codes that require prior authorization via our Online Prior Authorization Search Tool. Future changes to CPT or HCPCS codes that require PA will be communicated by Aetna Better Health in writing and on the home page of Aetna Better Health’s secure web portal. Are you asking for precertification on a specialty drug for a commercial or Medicare member? NCCI Procedure-to-Procedure Lookup The Medicare National Correct Coding Initiative (NCCI) (also known as CCI) was implemented to promote national correct coding methodologies and to control improper coding leading to inappropriate payment. Modifier selections will populate for the code, if applicable. For specialty drug precertification requests for commercial and Medicare members, providers should submit through Novologix, also available via Availity. Use our “Search by CPT® code” function on our NPL page to find out if the code requires precertification. Prior authorization is required [for some out-of-network providers, outpatient care and planned hospital admissions]. You'll need to enter your Aetna provider ID number (PIN) to access our code edit lookup tools. Sep 1, 2023 · Effective September 1, 2023, Aetna Better Health of New Jersey will require prior authorization for the set of codes listed below for participating providers. This document includes an overview of best practices for working with Gravie and Current Procedural Terminology (CPT®) codes for services, programs and prescriptions that require approval for coverage. Learn how to request prior authorization here. Search result definitions: YES - Prior authorization request is required for this service. The portal is a one-stop shop to complete enrollment and maintain provider details, and it satisfies the federal requirements of the 21st Century Cures Act for all Medicaid providers. Future changes to CPT or Healthcare Common Procedure Coding System (HCPCS) codes that require PA will be communicated by Aetna Better Health Premier Plan in writing and on the homepage of Aetna Better Health’s secure web portal. Starting November 1, 2022, Aetna® will no longer reimburse providers for office consultation codes 99241, 99242, 99243, 99244 and 99245. Feb 10, 2025 · Providers can verify whether a CPT® code requires precertification by using the “Search by CPT® code” tool on the NPL page. Find articles on fitness, diet, nutrition, health news headlines, medicine, diseases Discover all of our resources for health care professionals and join the Aetna providers network. A current list of the services that require authorization is available on the Provider Portal, through our Provider Prior Authorization Tool (ProPAT). Explore the medical clinical policy bulletins that Aetna uses to decide which services and procedures we will cover. PA requirement results are valid as of today's date only. Aug 27, 2025 · Aetna Assure Premier Plus (HMO D-SNP) providers follow prior authorization guidelines. Information provided during this search is current as of today's date for the individual group number and member entered. Experimental, Investigational, or Unproven The following procedures are Jun 8, 2022 · The CPT codes for procedures do include the evaluation services necessary before the performance of the procedure (e. If you are a non-participating provider, 100% of all services require a Prior Authorization. Providers can use these codes to report specific services that contribute to positive outcomes and high-quality care. Build relationships while helping patients with Aetna. Aug 19, 2024 · Use Codify for fast CPT code lookup and search. View Aetna Procedure Codes Sep 1, 2019 · Prior authorization is required for select, acute outpatient services and planned hospital admissions. , medical decision making and another key component) E/M services Effective June 1, 2020 Aetna Better Health of Pennsylvania will change the way unlisted and non-specific CPT and HCPCS codes are reviewed and paid. How To Search: Enter the Procedure Code and the Provider's Fee Schedule ID (FSID). See search results, definitions, exceptions and contact information for Aetna Better … Nov 15, 2022 · How to Search a CPT or HCPCS Code(s) in Propat & determine if PA Authorization is required? Step 1 – Enter CPT or HCPCS Code (s). If you need help understanding any of these guidelines, please call Provider Experience at 1-844-362-0934 (TTY: 711), Monday through Friday, 8 AM to 5PM. Jan 1, 2025 · CPT® copyright 2025 American Medical Association. Use our “Search by CPT® code” search function on our Precertification Lists page to find out if the code requires precertification. Apr 16, 2025 · Aetna Medicare offers tools to help you live healthier. Some of these services require prior authorization. CPT copyright 2022 American Medical Association. Search tools, index look-up, tips, articles and more for medical and health care code sets. This update applies to our commercial members. Effective September 1, 2023, Aetna® will deny unbundled services identified by CPT® codes 45499, 49329, 49650, 50715, 50949, 58578, 58679 and 64999 as incidental when billed with 58662 for the treatment of endometriosis. providers and its territories. Nov 25, 2024 · The North Carolina State Health Plan will transition to Aetna, its new third-party administrator effective January 1, 2025. Precertification Code Search Tool — allows you to enter up to five CPT codes at a time to quickly determine whether a medical precertification is required for your patient. Use the CPT code search tool to see if precertification is required. Use our “Search by CPT® code” search function on our precertification lists page to find out if the code requires precertification. The five character codes included in the Aetna Medicaid PA Requirement Search Tool are obtained from Current Procedural Terminology (CPT), by the American Medical Association (AMA). CPT® codes simplify how performance measures are reported and reduce the need for medical record requests. You can enter up to six Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) codes or a CPT group to search and determine if a PA is required for rendering services. Our Clinical Policy Bulletins (CPBs) explain the medical, dental and pharmacy services we may or may not cover. If you need precertification for a specialty drug for a commercial or Medicare member, submit your request through Novologix®, also available on Availity®. Search results, as well as, authorization are not a guarantee of claim payment. Search results, as well as authorization are not a guarantee of claim payment. REMOVAL OF SKIN LESION You can review their approve CPT codes here: Aetna Telehealth CPT Codes for Behavioral Health Treatment 2020 Like with all major insurance companies, Aetna requires mental health providers to utilize their normal range of CPT codes. May 1, 2025 · Updated May 1, 2025 This document is a quick guide for your ofice to use for precertification with patients enrolled in Aetna health plans. * Beginning January 1, 2025, Aetna® will administer the North Carolina State Health Plan network, and members will need to re-choose a primary care provider (PCP) in the fall of 2024. Working with Aetna® on Availity® This webinar provides an overview on how to use Availity to do business with us electronically. Get information about ICD-10 and the new HIPAA standards and learn what the International Classification of Diseases revisions and new standards mean for you. ProPAT CPT Code Lookup : Aetna Better Health Health (5 days ago) If you have any questions about authorization requirements or need help with the search tool, contact Aetna Better Health Provider Relations at 1-855-364-0974. ** If you need precertification for a specialty drug for a commercial or Medicare member, submit your request through Novologix®, also available on Availity. Jul 3, 2025 · The July 2025 Ambulatory Surgical Center Fee Schedule is now available in the ASC Fee Schedule Tool. Find articles on fitness, diet, nutrition, health news headlines, medicine, diseases Non-Specific Codes1/2017 4 days ago · The five character codes included in the Aetna Medicaid PA Requirement Search Tool are obtained from Current Procedural Terminology (CPT), copyright 2014 by the American Medical Association. Or use our precertification code search tool at the bottom of the page. Looking for Aetna Better Health Cpt Code Lookup ? Here, you can find the list of online sources that give you the best information available. Access CPT codes and get help in describing exactly what service a healthcare provider has performed. CPT is a registered trademark of the American Medical Association. PA is not needed for emergency care. Policy Scope of Policy This Clinical Policy Bulletin addresses endoscopic ultrasonography. hnt bqzrd hifunr hcmb yckdbmj otj zzafoq bfr cqbkmsed haah