Does Aetna require prior authorization for CPT J1745?

Yes. Aetna requires prior authorization for CPT J1745 (Infliximab - infliximab) under Standard commercial plans per its published clinical policy.

What documentation does Aetna require for CPT J1745?

Completed medical-drug precertification request; Diagnosis, drug, dose, site of care, and prior therapy records requested for Aetna review

What if Aetna denies the PA for CPT J1745?

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 J1745

Infliximab - infliximab · Standard commercial plans

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

Source

Aetna Commercial Medical Drug Clinical Program Summary 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's 2026 commercial medical-drug clinical program summary lists Remicade/infliximab code J1745 in the medical-benefit authorization program context. This row is limited to the named Remicade/infliximab medical-benefit context and should not be used as pharmacy-benefit or Medicare Part B proof.

Documentation checklist

✓Completed medical-drug precertification request
✓Diagnosis, drug, dose, site of care, and prior therapy records requested for Aetna review

Submission channels

Phone

1-866-503-0857

2026 Medicare rate for CPT J1745

CPT J1745 is not priced under the 2026 Medicare Physician Fee Schedule (status E) — drugs/biologicals price under ASP and lab tests under the CLFS. See the CPT J1745 code page for pricing detail.

How to submit the PA

1Verify the requirement against the current clinical policy linked above.
2Gather documentation: Completed medical-drug precertification request, Diagnosis, drug, dose, site of care, and prior therapy records requested for Aetna 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 J1745?: Yes. Aetna requires prior authorization for CPT J1745 (Infliximab - infliximab) under Standard commercial plans per its published clinical policy.
What documentation does Aetna require for CPT J1745?: Completed medical-drug precertification request; Diagnosis, drug, dose, site of care, and prior therapy records requested for Aetna review
What if Aetna denies the PA for CPT J1745?: 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 J0897 CPT G2211 CPT J3301 CPT J0585 CPT G0402 CPT G0439 CPT G0438 CPT J1885

All Aetna prior-authorization requirements →

CPT J1745 prior authorization by payer

Blue Cross Blue Shield Cigna Humana TRICARE Medicare Anthem

Draft the Aetna PA request for CPT J1745 — free

Ask D3 builds a payer-ready prior-authorization request with the right criteria language and documentation — backed by CMS, Medicare, and major-payer data. No signup.

Draft the J1745 PA in Ask D3 Look up another payer or code