Aetna Resources

IMPORTANT UPDATE: The following CPT codes have been removed from the Aetna Vascular Intervention program, effective immediately.

• 37246
• 37247
• 37252
• 37253

Aetna® is partnering with EviCore to provide their members with access to specific procedures for Peripheral Vascular Disease. Effective for dates of service 9/1/23 and beyond, certain Vascular Intervention procedures will require prior authorization for Aetna Medicare, Commercial Fully-Insured, and Individual & Family (IFP) Plans. More detailed information can be found under Solution Resources/Cardiovascular.

Effective 5/27/2022, Aetna® Interventional Pain and Sleep authorizations must be initiated online through the CareCore National Portal, rather than through the MedSolutions Portal. More detailed information can be found under the 'General Resources' tab.

Effective 11/24/2021, Aetna® Radiology and Cardiology authorizations must be initiated online through the CareCore National Portal, rather than through the MedSolutions Portal. More detailed information can be found under the 'General Resources' tab.

Effective December 1, 2021, Aetna® will add a Site of Care medical necessity requirement to the Enhanced Clinical Review program for fully insured commercial members. As part of this change, advanced radiology imaging procedures (MR and CT scans) will be reviewed by EviCore by Evernorth for applicable medical necessity criteria prior to authorization of services in the hospital outpatient setting. More detailed information can be found under the Radiology 'Solution Resource' tab.

Effective 8/30/2021, EviCore will cease processing new Hip and Knee arthroplasty prior authorization requests for Aetna, all open cases will continue to be processed and reviewed until completion. New cases should be completed on Availity.com. If you have any questions, please call Aetna’s Provider Contact Centers at 1-888-632-3862

Current list of services that require pre-approval:

-CT, CTA (Computed Tomography, Computed Tomography Angiography) 
- MRI, MRA (Magnetic Resonance Imaging, Magnetic Resonance Angiography) 
- PET (Positron Emission Tomography) 
- NCM/MPI (Nuclear Cardiac Imaging) 
- Stress Echocardiograms 
- Diagnostic Heart Catherizations
- Insertion, removal and upgrade of elective implantable cardioveter defibrillator; Cardiac Resynchronization Therapy-defibrillator and implantable pacemaker. 
- Polysomnography (attended sleep studies)
- Interventional Pain

Services that require pre-approval effective July 1, 2019:

- 2D and 3D conformal
- SRS/SBRT 
- Brachytherapy 
- IMRT 
- Proton Beam