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AetnaCommercial · Prior Auth · Newsletter · Oncology, Hematology, OB-GYN +3 moreHigh impact

OfficeLink Updates - October 2026 notices and reminders (PDF)

Effective date
Jan 1, 2027
Identified
Sep 24, 2026

Summary

Already effective September 1 and October 1, 2026, Aetna requires precertification for drugs including Lytenava, Tudriqev, Genglycos, Pasatru, Zanvastro, and Elzonris, and requires Site of Care review for Zimrixby, Jobevne, and Avzivi. Precertification is no longer required for commercial members for OrthoVisc, Zarxio, several bortezomib products, and Fusilev, and it is no longer required for Medicare for several bortezomib products and Fusilev. Effective January 1, 2027, trauma response charges reported with revenue codes 0681 through 0684 will be denied unless a paid HCPCS code G0390 and a paid qualifying ambulance transport charge are billed on the same date of service.

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What to do

Action · 7 steps
01Already effective September 1 and October 1, 2026: For drugs that now require precertification or Site of Care review, submit requests at least two weeks in advance and include the actual date of service.
02Submit through the Aetna provider portal on Availity, or through your EMR if it is set up for electronic precertification requests.
03Use the Search by CPT code function on the Precertification Lists page to check whether a code requires precertification.
04Submit specialty drug requests for commercial or Medicare members through Novologix on Availity.
05Effective January 1, 2027: Billing team must bill trauma response revenue codes 0681, 0682, 0683, or 0684 with a paid G0390 and a qualifying ambulance transport service billed and paid on the same date of service, and all services must support the documented trauma activation event.
06Review billing practices and coding workflows so claims for CPT 81595 with 93505, and CPT 0540U with 50200, 50205, 50542, or 93505, are submitted in line with the reimbursement requirements, since those combinations will be denied as incidental on the same date of service.
07Providers: if a drug moves from the medical benefit to the pharmacy benefit, you may need to issue a prescription to an in-network specialty pharmacy, or submit a new PA if you transition the patient to a preferred alternative under the medical benefit.

Codes mentioned

J3490J3590C9399J9269Q5160J9999J7324Q5101J9046J9049J0641J9041J9048J9011Q5110J9205J2802J9248J9039J9246J2783J9266J9021J7355J9184J7190C9310J9072J930193580G03908159593505502005020550542

Original notice

OfficeLink Updates - October 2026 notices and reminders (PDF)
aetna.com · Always check the source before changing claims.
View original ↗

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Related policy hubs

Aetna policiesOncologyHematologyOB-GYNCardiologyNephrologyPathologyCode J3490Code J3590Code C9399Code J9269Code Q5160Code J9999Code J7324Code Q5101Code J9046Code J9049Code J0641Code J9041Code J9048Code J9011Code Q5110Code J9205Code J2802Code J9248Code J9039Code J9246Code J2783Code J9266Code J9021Code J7355Code J9184Code J7190Code C9310Code J9072Code J9301Code 93580Code G0390Code 81595Code 93505Code 50200Code 50205Code 50542

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