Alpha1-Proteinase Inhibitors (CPB 0145, reviewed 2026-03-24)

By March 24, 2026: (1) Billing team must update all systems to require mandatory precertification for CPT J0256 and J0257 alpha1-proteinase inhibitor claims before claim submission—contact Aetna precertification at (866) 752-7021 or fax (888) 267-3277. (2) Modify encounter forms and clinical documentation templates to capture required data: pretreatment AAT serum levels (<11 micromol/L threshold), post-bronchodilation FEV1 percentage (25-80% required), AAT phenotype/genotype (PiZZ, PiZ null, Pi null-null only; exclude PiMZ and PiMS), and GVHD steroid-refractory status. (3) Update claims billing rules to reject claims billed with excluded ICD-10 codes (D80.2, E84.0-E84.9, J80, T86.90-T86.99) as non-covered. (4) Implement site-of-service utilization management per Aetna's specialty drug infusion policy. (5) Train front-desk and prior auth staff on new submission requirements. (6) For continuous therapy approvals, ensure documentation of 'beneficial clinical response' is present. Failure to obtain precertification will result in automatic claim denials; claims lacking required clinical documentation will be denied as not meeting medical necessity criteria.