Medicare AdvantagePrior AuthHigh impact
OfficeLink Updates - November 2024 notices and reminders (PDF)
Aetna·Orthopedics, Sports Medicine, Endocrinology +1 more·Newsletter
Effective date
Jan 1, 2025
We identified it
Jun 23, 2026
Summary
Aetna is adding prior authorization requirements for knee arthroscopy procedures and Lupron depot injections for Medicare plans starting February 1, 2025, while removing precertification requirements for two specialty drugs (Parsabiv and Korsuva) effective January 1, 2025. These changes only affect Medicare plan members.
Action Required
By January 31, 2025: Update billing system to require prior authorization for knee arthroscopy codes 29875, 29876, 29877, 29879 and Lupron depot (J1950) for Medicare plans effective February 1, 2025. Remove precertification requirements for Parsabiv (J0606) and Korsuva (J0879) effective January 1, 2025. Submit all precertification requests at least two weeks in advance through Availity portal. Claims without required precertification will be denied.