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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.
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.
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.
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.
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.
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.
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.
Prior authorization is a request to Aetna for you to get special services or see a specialist. Your clinical team or PCP requests prior authorization before the service is rendered. You do not need a referral or prior authorization to get emergency services. How it works.
Visit the secure website, available through www.aetna.com, for more information. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search." The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT ®), copyright 2023 by the American Medical Association ...