Changes to Aetna National Precertification List (NPL)
As published in the March 1, 2021, edition of Aetna Officelink Updates™
As of July 1, 2021, these precertification changes apply:
- We’ll require precertification for:
- Cataract surgery
- Sacroiliac joint fusion surgery
- Knee arthroscopy with meniscectomy
- Vertebral corpectomy procedures
- Additional lower limb prosthetic codes including select foot, ankle and vacuum pump components
- Spinraza® (nusinersen) – precertification required for both the drug and site of care.
Submitting requests
Be sure to submit authorization requests at least two weeks in advance.
To save time, you can make your request online. Doing so is fast, secure and simple. You can submit most requests online through our provider portal on Availity. Or you can use the Electronic Medical Record (EMR) system portal.
Are you asking for drug prior authorization on a specialty drug for a commercial or Medicare member? Then submit your request through Novologix®, also available on Availity®.
Not registered for Availity?
Register online or call 1-800-AVAILITY (1-800-282-4548). For one-on-one support from us, call Aetna at 1-866-752-7021. Then ask to talk with the Availity team.
You can use our “Search by CPT code” search function on our Precertification Lists web page to find out if the code needs precertification.
You can learn more about precertification under the General Information section of the NPL.