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OfficeLink Updates - January 2025 notices and reminders (PDF)
Act
by Apr 1, 2025
Effective date
Apr 1, 2025
Identified
Jun 23, 2026
Summary
Aetna is implementing multiple billing changes effective April 1, 2025, including reducing reimbursement for nurse practitioner/midwife services to 85%, requiring CPAP adherence documentation for reimbursement, and removing precertification requirements for certain neurostimulator devices and Skyrizi injections. Drug formulary changes will also take effect with proactive prior authorizations issued.
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What to do
by Apr 1, 2025 · 4 steps
01Billing team must update system to pay SA/SB modifier claims at 85% of allowed amount instead of 100%.
02For CPAP claims, require adherence codes G8851, G8854, or G8855 on all claims or they will be denied.
03Remove precertification requirements for codes J2327, C1767, C1816, C1820, and C1822.
04By February 1, 2025: Review Medical Clinical Policy Bulletins page for drug formulary changes and update prior authorization workflows accordingly.
Codes mentioned
J2327C1767C1816C1820C1822814258142681427G8851G8854G8855
Original notice
OfficeLink Updates - January 2025 notices and reminders (PDF)
aetna.com · Always check the source before changing claims.
Related changes
See all Aetna changes →Diabetic Neuropathy: Selected Treatments (CPB 0729, reviewed 2026-10-21)MediumNo effective date · Medical PolicySpinal Cord Stimulation (CPB 0194, reviewed 2026-09-10)MediumNo effective date · Medical PolicySpinal Cord Stimulation (CPB 0194, reviewed 2026-05-21)MediumNo effective date · Medical PolicyDiabetic Neuropathy: Selected Treatments (CPB 0729, reviewed 2026-02-24)MediumNo effective date · Medical PolicyBrowse every Aetna change in the policy list