Prior Authorization
Aetna Prior Authorization for CPT 58974
Infertility diagnostic and treatment services · Standard commercial plans
Source
Aetna Participating Provider Precertification List 2026 (Updated May 1, 2026)Not medical advice. PA policies change frequently. Always confirm against the payer's current policy before submitting. d3rx pulls directly from publicly published policy PDFs and refreshes daily.
Clinical criteria
Aetna lists this code under Services that require precertification: Infertility services and pre-implantation genetic testing, with the infertility program phone listed in Special programs. Applicability depends on plan benefits and listed program rules. Evidence: PDF p.8 and p.34, Services/Special programs infertility program.
Documentation checklist
- ✓Completed infertility program precertification request
- ✓Medical records requested for Aetna clinical review
Submission channels
Phone
1-800-575-59992026 Medicare rate for CPT 58974
CPT 58974 is not priced under the 2026 Medicare Physician Fee Schedule (status C) — drugs/biologicals price under ASP and lab tests under the CLFS. See the CPT 58974 code page for pricing detail.
How to submit the PA
- 1Verify the requirement against the current clinical policy linked above.
- 2Gather documentation: Completed infertility program precertification request, Medical records requested for Aetna clinical review.
- 3Submit via phone, or the payer portal.
- 4Document the reference number and follow up within 5 business days if no determination is received.
FAQ
- Does Aetna require prior authorization for CPT 58974?
- Yes. Aetna requires prior authorization for CPT 58974 (Infertility diagnostic and treatment services) under Standard commercial plans per its published clinical policy.
- What documentation does Aetna require for CPT 58974?
- Completed infertility program precertification request; Medical records requested for Aetna clinical review
- What if Aetna denies the PA for CPT 58974?
- Appeal in writing within 60 days, citing the specific clinical policy criteria the case meets and attaching supporting documentation. Many denials are reversed on first-level appeal when the criteria language is mirrored.
Other Aetna PA lookups
CPT 58974 prior authorization by payer
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