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2008 Aetna Participating Provider Precertification List*
Guidelines for Determining Coverage | Clinical Policy Bulletins | Medicare | Payment Policy | Dispute Process
You can use our code search to find out if a specific code requires a precertification or access the complete precertification listing below. When using the code search, please enter only valid 5-digit codes to get an accurate response. This tool will also assist you with determining if a Special Program may apply (see item #14 below). Applies to: Aetna Choice®, Aetna Choice® POS II, Aetna Golden ChoiceTM , Aetna Golden Medicare Plan®, Aetna Golden Medicare Open Access®, Aetna Golden Medicare Dual Advantage Plan, Aetna Golden Choice Care Advantage, all Aetna HealthFund® products, Aetna Health Network OnlySM, Aetna Health Network OptionSM, Aetna Open Access® Elect Choice®, Aetna Open Access® HMO, Aetna Open Access® Managed Choice®, Open Access Aetna SelectSM, Elect Choice®, HMO, Managed Choice® POS, Open Choice®, Quality Point-of-Service® (QPOS®) and USAccess® benefits plans and all products that may include the Aexcel® networks and include the designation Aexcel or Aexcel Plus®** Precert exceptions Please see the Exceptions to Aetna Precert List box on the right hand side of this page. Precertification List 
Download/Print 2008 Precertification List in PDF format  (2 pages)
1. Inpatient confinements
2. Reconstructive procedures that may be considered cosmetic
3. Artificial intervertebral disc surgery 4. Lumbar spinal fusion surgery 5. Uvulopalatopharyngoplasty, including laser-assisted procedures 6. Orthognathic surgery procedures, bone grafts, osteotomies and surgical management of the temporomandibular joint 7. Dental implants and oral appliances 8. Elective (non-emergent) transportation by ambulance or medical van, and all transfers via air ambulance 9. The following conditionally eligible services†
10. Medical injectables
11. All home health care services, including home uterine monitoring 12. Selected durable medical equipment
13. In-network level of benefits for nonparticipating physicians and providers for non-emergent services††, only when there is an identified network deficiency. (This category does not apply to Open Choice members.) 14. Special programs
See footnotes at bottom of this page
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Exceptions to Aetna Precert List
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*The term precertification here means the utilization review process to determine whether the requested service, procedure, prescription drug or medical device meets the company's clinical criteria for coverage. It does not mean precertification as defined by Texas law, as a reliable representation of payment of care or services to fully insured HMO and PPO members. **Not all plans are offered in all service areas. Precertification is required when Aetna is secondary payer. †All services deemed "never effective" are excluded from coverage. Aetna defines a service as "never effective" when it is not recognized according to professional standards of safety and effectiveness in the United States for diagnosis, care or treatment. Visit the secure website, available through www.aetna.com, for more information. Select "Claims,” "CPT/HCPCS Coding Tool," "Clinical Policy Code Lookup." ††All products that include Aetna HealthFund, Aexcel Plus products, Aetna Health Network Option products, Aetna Choice, Choice POS II, Golden Choice Plan, Open Access Managed Choice, QPOS and USAccess benefits plans may include the option for members to elect to go outside the network and receive reduced benefits. |
