Prior Authorization · 2026
Aetna Prior Authorization Requirements
A source-backed map of which procedures Aetna requires prior authorization for — pulled directly from Aetna's own published clinical-policy PDFs and refreshed regularly.
936
procedure codes that require prior auth
938
source-backed PA policy entries
1
commercial plan line
100%
cited to published policy
Does Aetna require prior authorization?
Yes. Aetna requires prior authorization for a wide range of imaging, surgical, specialty-drug, and outpatient services. d3rx tracks 936 procedure codes that Aetna requires PA for (of 938 services we map for this payer), every one tied to a published Aetna policy document and last verified May 9, 2026. Look up your exact CPT code below for the verdict, documentation, and policy citation.
Sources
Every Aetna verdict on d3rx is extracted from these published policy documents — not generated. Always confirm against the carrier's current policy before submitting.
Most-requested procedures that need Aetna prior auth
High-volume CPT/HCPCS codes Aetna requires prior authorization for. Open any code for the full source-backed verdict and documentation checklist.
- CPT J1745PA required
Infliximab - infliximab
- CPT 97161PA required
Physical therapy evaluation, low complexity, typically 20 minutes
- CPT 70450PA required
Radiology imaging
- CPT 62323PA required
Interlaminar epidural or subarachnoid injection, lumbar or sacral, with imaging guidance
- CPT 97110PA required
Therapeutic exercises to build strength, flexibility, or endurance
- CPT 27130PA required
Total hip arthroplasty
- CPT 27447PA required
Total knee arthroplasty
- CPT 58571PA required
Abdominal and laparoscopic hysterectomy
- CPT 58661PA required
Gender dysphoria treatment (with specific diagnosis codes)
- CPT 64483PA required
Epidural injection, lumbar/sacral
- CPT 64493PA required
Site of service - Muscular/skeletal procedures (outpatient hospital/ASC only)
- CPT 64635PA required
Site of service - Neurologic procedures (outpatient hospital/ASC only)
- CPT 66984PA required
Site of service - Cataract surgery (outpatient hospital only)
- CPT 70551PA required
MRI brain without contrast
- CPT 70553PA required
MRI brain with and without contrast
- CPT 71250PA required
CT of thorax diagnostic and CT angiography of chest (noncoronary) with various contrast protocols
- CPT 71260PA required
CT of thorax diagnostic and CT angiography of chest (noncoronary) with various contrast protocols
- CPT 71271PA required
Radiology imaging
- CPT 71275PA required
CT of thorax diagnostic and CT angiography of chest (noncoronary) with various contrast protocols
- CPT 72141PA required
MRI and MR angiography of spinal canal and contents (cervical, thoracic, lumbar) with various contrast protocols
- CPT 72148PA required
MRI lumbar spine without contrast
- CPT 72197PA required
CT and MRI of pelvis and CT/MR angiography of pelvis with various contrast protocols
- CPT 73221PA required
MRI joint of upper extremity without contrast
- CPT 73721PA required
MRI joint of lower extremity without contrast
+ 108 more high-demand Aetna codes. Look up any CPT code →
Aetna prior-authorization contacts
Fax
- 1-800-540-2406
- 1-855-774-1319
- 1-860-754-5670
How to get Aetna prior authorization approved
- 1Confirm the requirement: look up the exact CPT code above to see whether Aetna requires PA and under which plan line.
- 2Gather documentation: clinical notes, history of conservative treatment, imaging/test results, and a clear statement of medical necessity matching the policy criteria.
- 3Submit via the Aetna provider portal (or the phone/fax channel for the relevant program), attaching the documentation.
- 4Record the reference number and follow up within 5 business days if no determination is returned. If denied, appeal in writing within 60 days, mirroring the policy's exact criteria language.
Aetna prior authorization FAQ
- Does Aetna require prior authorization?
- Yes. Aetna requires prior authorization for a wide range of imaging, surgical, specialty-drug, and outpatient services. Our source-backed dataset tracks 936 procedure codes that Aetna requires prior authorization for, compiled from 3 published Aetna policy documents and last verified May 9, 2026. Requirements vary by procedure and plan, so confirm the specific CPT code before scheduling.
- How do I check whether Aetna requires prior authorization for a specific CPT code?
- Enter the exact CPT or HCPCS code in the free d3rx PA lookup, or pick from the most-requested procedures listed on this page. Each opens the source-backed verdict for Aetna, the documentation required, and a link to the underlying policy PDF.
- What documentation does Aetna require for prior authorization?
- Typical requirements include clinical notes, history of conservative treatment, relevant imaging or test results, and a clear statement of medical necessity. The exact documents vary by procedure and are listed on each code's page.
- How long does Aetna prior authorization take?
- Standard Aetna commercial determinations are generally returned within 5–14 business days for non-urgent requests, and within 72 hours for urgent (expedited) requests, per state-regulated and contractual timelines.
- How do I submit a Aetna prior authorization request?
- Submit via the Aetna provider portal, or by phone (1-888-622-7329, 1-888-632-3862) or fax (1-800-540-2406, 1-855-774-1319) for the relevant program. Include the documentation listed on the procedure's page and record the reference number for follow-up.
Draft a Aetna prior-auth request — free
Ask D3 pulls from the same source-backed dataset plus denial and appeal playbooks. Get the documentation checklist and a ready-to-send request for any Aetna procedure — no signup.
Other payer prior-authorization hubs
Prior authorization disclaimer
This page summarizes Aetna prior-authorization data extracted from the carrier's published policy documents for educational purposes. PA requirements change frequently and vary by individual plan. Always verify requirements directly with Aetna before performing a procedure. d3rx is not responsible for claim denials or reimbursement issues.