What documentation does Aetna require for CPT 99183?

Completed precertification request; Medical records requested for Aetna clinical review

How much does Medicare pay for CPT 99183 in 2026?

In 2026, the national Medicare allowable for CPT 99183 is $109.55 in an office setting and $109.55 in a facility. Commercial allowables for Aetna are typically negotiated against this benchmark.

What if Aetna denies the PA for CPT 99183?

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.

Prior Authorization

Aetna Prior Authorization for CPT 99183

Physician attendance and supervision of hyperbaric oxygen therapy and unlisted special service, procedure or report · Standard commercial plans

Prior authorization REQUIREDApplies to all statesLast verified May 9, 2026 · Reviewed by the D3rx Clinical Billing Team

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: Hyperbaric oxygen therapy. The PDF states precertification is required for commercial members only for this item. Evidence: PDF p.8, Services that require precertification, item 19.

Documentation checklist

✓Completed precertification request
✓Medical records requested for Aetna clinical review

2026 Medicare rate for CPT 99183

Office (non-facility)

$109.55

Facility

$109.55

Total RVUs (office)

3.28

Conversion factor

$33.4009

National Medicare Physician Fee Schedule amounts (GPCI 1.0). Aetna's commercial allowable is negotiated against this benchmark — see the full RVU and locality breakdown on the CPT 99183 code page.

How to submit the PA

1Verify the requirement against the current clinical policy linked above.
2Gather documentation: Completed precertification request, Medical records requested for Aetna clinical review.
3Submit via the payer's provider portal or designated PA channel.
4Document the reference number and follow up within 5 business days if no determination is received.

FAQ

Does Aetna require prior authorization for CPT 99183?: Yes. Aetna requires prior authorization for CPT 99183 (Physician attendance and supervision of hyperbaric oxygen therapy and unlisted special service, procedure or report) under Standard commercial plans per its published clinical policy.
What documentation does Aetna require for CPT 99183?: Completed precertification request; Medical records requested for Aetna clinical review
How much does Medicare pay for CPT 99183 in 2026?: In 2026, the national Medicare allowable for CPT 99183 is $109.55 in an office setting and $109.55 in a facility. Commercial allowables for Aetna are typically negotiated against this benchmark.
What if Aetna denies the PA for CPT 99183?: 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.

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