CommercialPrior AuthHigh impact
OfficeLink Updates - April 2025 notices and reminders (PDF)
Aetna·Oncology, Genetics, Psychiatry +1 more·Newsletter
Effective date
Jul 1, 2025
We identified it
Jun 23, 2026
Summary
Aetna updated their National Precertification List with multiple new drug requirements and removed precertification for BRCA genetic testing. Several new specialty drugs now require precertification with staggered effective dates from March through April 2025, and new claim edits will be implemented starting July 1, 2025.
Action Required
Immediately: Update billing system to require precertification for new specialty drugs (Ziihera, Bizengri, Unloxcyt, Opdivo Qvantig, Jubbonti, Wyost, Datroway, Ryoncil) using codes J3490, J3590, C9399, J9999. Remove precertification requirement for BRCA testing (81433). By July 1, 2025: Update system to deny FIT/FOBT codes 82270, 82274, G0328 when billed within one year of colonoscopy or related procedures. Limit psychiatric evaluation codes 90791, 90792 to once every six months for commercial members. Train staff on new claim edits and code lookup tools in Availity portal.