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OfficeLink Updates - August 2026 notices and reminders (PDF)
Effective date
Nov 14, 2026
Identified
Jul 30, 2026
Summary
Aetna precertification applies to Ranluspec, Tregzi and Decnupaz effective August 1, 2026, and to Sarclisa Escena and Revtorpyk effective September 1, 2026. Effective November 1, 2026, CPT 77436 (SGRT) is limited to one reimbursement for the entire course of treatment, and Site of Care precertification applies to commercial Oziltus (Q5165); beginning November 14, 2026, professional claims for CPT 90963 to 90966 with an inappropriate place of service may result in claim denial. New Claim and Code Review Program edits may appear beginning November 23, 2026, and global maternity codes are retired beginning January 1, 2027.
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What to do
Action · 13 steps
01Already effective August 1, 2026: Submit precertification for Ranluspec, Tregzi, Decnupaz and Lumvoa at least two weeks in advance and include the actual date of service.
02Submit online through the Availity portal, or through the EMR system if it is set up for electronic precertification requests, and use Search by CPT code on the Precertification Lists page to confirm a code requires precertification.
03Lumvoa also requires Site of Care review.
04Specialty drug precertification requests for commercial or Medicare members go through Novologix on Availity.
05Already effective September 1, 2026: Submit precertification for Sarclisa Escena and Revtorpyk using the same process.
06Starting September 1, 2026: For patients expected to deliver in 2027, bill preventive prenatal office visits on or after that date with the applicable E/M code, modifier TH and pregnancy diagnosis code(s).
07Already effective October 1, 2026: For Datroway and Omisirge, Site of Care review is no longer required, and precertification remains.
08Already effective November 1, 2026: Request Site of Care precertification for commercial Oziltus (Q5165).
09Already effective November 1, 2026: Check the Radiation Therapy Payment Policy on Availity and confirm CPT 77436 is billed only once per course of treatment and that supporting documentation reflects the treatment planning and simulation services performed.
10Claims with multiple units of CPT 77436 during the same course of treatment may be subject to denial or adjustment.
11By November 14, 2026: Review billing processes so CPT 90963 to 90966 are reported with the appropriate place of service before claim submission, since submitting them with an inappropriate place of service may result in claim denial beginning November 14, 2026.
12Beginning November 23, 2026: Log in to Availity and use the Code Edit Lookup Tools with your Aetna provider ID number to check whether new claim edits apply to your claims.
13Future transition January 1, 2027: Review the AMA maternity care coding resources listed in the notice and watch for the additional coding, valuation, reimbursement and fee schedule information the notice says is still to come.
Codes mentioned
J3490J3590C9399J9999J9011Q51657743690963909649096590966
Original notice
OfficeLink Updates - August 2026 notices and reminders (PDF)
aetna.com · Always check the source before changing claims.
Related changes
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