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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.
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.
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.
Provider Search is provided solely for the personal, non-commercial use of current and prospective Aetna members and providers.
The provider search tool will display results as Maximum Savings and Standard Savings. Maximum Savings - the highest level of coverage (Tier I): Providence and its affiliated providers, faciliCes, clinics and select provider partners. Standard Savings (Tier II) = Aetna-contracted in-network providers, faciliCes & clinics.
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Find out about all of the resources available to health care professionals and learn how to join the Aetna providers network.
Participating providers can now check for codes that require prior authorization via our Online Prior Authorization Search Tool. If you are a non-participating provider, 100% of all services require a Prior Authorization.
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
Here are the ways you can request prior authorization: Online. You can request prior authorization through our Provider Portal. By Phone. You can request prior authorization by calling us at 1-866-329-4701 (TTY: 711). By fax. Download our prior authorization form.