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Clotting Factors (CPB 0131, reviewed 2026-04-23)
Effective date
Not stated in the notice
Identified
Aug 13, 2026
Summary
Aetna's clotting factor policy applies to commercial medical plans, and the Medicare criteria are set out separately in the Medicare Part B Criteria. Precertification of clotting factors is required of all Aetna participating providers and members in applicable plan designs, and it is requested through Aetna's Special Case Precertification Unit at (855) 888-9046. Clotting factor products must be prescribed by or in consultation with a hematologist, and Aetna considers all other indications experimental, investigational, or unproven.
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What to do
Action · 9 steps
01Billing team: Precertification of clotting factors is required in applicable plan designs.
02For precertification, call Aetna's Special Case Precertification Unit at (855) 888-9046.
03Confirm that each prescription is written by or in consultation with a hematologist.
04For hemophilia A, document either mild disease with an insufficient response to desmopressin or a documented clinical reason for not using desmopressin (see Appendix B), or moderate or severe disease (see Appendix A).
05For FEIBA and NovoSeven, document an inhibitor titer of 5 Bethesda units per milliliter or greater, or a history of such a titer, in hemophilia A or B with inhibitors.
06Aetna considers members less than 12 years of age not eligible for Sevenfact.
07For emicizumab (Hemlibra), the member must not use it in combination with Alhemo, Hympavzi, or Qfitlia, and prophylactic factor VIII products must be discontinued after the first week of starting therapy.
08For reauthorization, document that the member is experiencing benefit from therapy, such as reduced frequency or severity of bleeds.
09Aetna considers all other indications experimental, investigational, or unproven.
Codes mentioned
J7165J7169J7170J7172J7173J7174J7175J7179J7180J7181J7182J7183J7185J7186J7187J7188J7189J7190J7191J7192J7193J7194J7195J7197J7200J7201J7202J7203J7204J7205J7207J7208J7209J7210J7211J7212J7213D66D67D68.01D68.020D68.021D68.022D68.023D68.03D68.04D68.1D68.2D68.311D68.32D68.4D68.59T45.515A
Original notice
Clotting Factors (CPB 0131, reviewed 2026-04-23)
aetna.com · Always check the source before changing claims.
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Related policy hubs
Aetna policiesHematologyCode J7165Code J7169Code J7170Code J7172Code J7173Code J7174Code J7175Code J7179Code J7180Code J7181Code J7182Code J7183Code J7185Code J7186Code J7187Code J7188Code J7189Code J7190Code J7191Code J7192Code J7193Code J7194Code J7195Code J7197Code J7200Code J7201Code J7202Code J7203Code J7204Code J7205Code J7207Code J7208Code J7209Code J7210Code J7211Code J7212Code J7213Code D66Code D67Code D68.01Code D68.020Code D68.021Code D68.022Code D68.023Code D68.03Code D68.04Code D68.1Code D68.2Code D68.311Code D68.32Code D68.4Code D68.59Code T45.515A