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Changes to our National Precertification List (NPL)


This update applies to both our commercial and Medicare members.


The following precertification changes become effective January 1, 2023.


We will require precertification for:


  • Additional codes for arthroscopic hip surgery to repair impingement syndrome, including labral repair
  • Vertebroplasty
  • Kyphoplasty

We will require precertification for the following breast and ovarian cancer susceptibility gene testing:


  • Multigene panels for hereditary breast cancer–related disorders (e.g., hereditary breast cancer, hereditary ovarian cancer and hereditary endometrial cancer)
  • Aetna® considers germline multigene panel testing for moderate- to high-penetrance breast and/or epithelial ovarian cancer susceptibility genes (must include BRCA1, BRCA2, CDH1, MLH1, MSH2, MSH6, PALB2, PTEN, STK11 and TP53) and full duplication and deletion analysis (i.e., detection of large genomic rearrangements) (must include BRCA1, BRCA2, MLH1, MSH2 and STK11) to be medically necessary once per lifetime for those who meet one or more National Comprehensive Cancer Network (NCCN) testing criteria for high-penetrance breast cancer susceptibility genes.
  • Asymptomatic individuals who have a family history that meets criteria for testing and who do not have a causative variant already identified should not rely solely on BRCA1 or BRCA2 gene testing, since the current standard of care includes moderate-high penetrance gene analysis to guide future screening and management recommendations. Accordingly, multigene panel tests should be submitted for this testing, which was formerly described as “BRCA testing.”

Reminder: Effective July 1, 2022, we no longer require precertification for cataract surgery managed by Aetna.


Cataract surgery for Florida and Georgia Medicare Advantage members will continue through iCare. Use the telephone numbers listed below for Medicare members in those states:


  • Georgia Medicare only (MEHMO and MEPPO) — contact iCare at 1-844-210-7444
  • Florida Medicare only (MEHMO and MEPOS) — contact iCare at 1-855-373-7627


Submitting precertification requests


Be sure to submit precertification requests at least two weeks in advance. To save time, request precertification online. Doing so is fast, secure and simple.


You can submit most requests online through our Availity provider portal.* Or you can use your practice’s Electronic Medical Record (EMR) system if it’s set up for electronic precertification requests. Use our “Search by CPT code” search function on our precertification lists page to find out if the code requires precertification.


Learn more about precertification.


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.


Not registered for Availity? Go to Availity to register and learn more.


*Availity is available only to U.S. providers and its territories.

Legal notices

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 affiliates (Aetna).

Health benefits and health insurance plans contain exclusions and limitations.

Also of interest: