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OfficeLink Updates - November 2026 notices and reminders (PDF)
Effective date
Jan 1, 2027
Identified
Oct 29, 2026
Summary
Aetna's November 2026 OfficeLink newsletter, issued 2026-11-01, covers several changes with different dates. The biggest is a restructuring of maternity care coding, with global maternity codes retired and replaced by service-based codes effective January 1, 2027, plus a transition period for prenatal preventive visits that began September 1, 2026. It also adds precertification for several specialty drugs on staggered dates from November 1, 2026 through February 1, 2027, and notes a Medicare MolDX molecular testing Z-code requirement that has no stated date and an observation reminder that is already in effect.
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What to do
Action · 17 steps
01Already effective Nov.
021, 2026: Prior authorization staff should request precertification for Isembyld (apitegromab-mstn) and Fayuvi (rebisfligene etisparvovec-hopf) under the drug codes J3490, J3590 and C9399 before those drugs are scheduled.
03Already in place: the observation reminder states that Medicare requires G0378 to be billed with at least eight hours of units, and that observation billed for less than eight hours is not reimbursable, so check charge entry for this code.
04From Sept.
051, 2026: for patients expected to deliver in 2027, bill preventive prenatal visits with the applicable E/M code, modifier TH and the pregnancy diagnosis code when three or fewer visits occur before Jan.
061, 2027.
07Front desk and providers should not use modifier TH on nonroutine prenatal or postpartum visits, since those are subject to member cost share.
08By Jan.
091, 2027: the OB/GYN billing team should prepare to report maternity care with the new service-level codes (antepartum, labor management, delivery and postpartum).
10Aetna says the framework is final but implementation details are still to come, so update charge entry once those details are published.
11Also by Jan.
121, 2027: request precertification for Bexlutry and Bravnetsa (J3490, J3590, C9399, J9999, A9699), for aflibercept-boav (J3490, J3590, C9399, Q5170), and for Degevma (denosumab-adet) (J3490, J3590, C9399), which also needs a site of care review for commercial members.
13By Feb.
141, 2027: request precertification for bendamustine (Avyxa) (J9066), commercial precertification for docetaxel (Hospira) (J9232), commercial precertification for Kyxata (carboplatin) (J9278), precertification for custom microprocessor controlled KAFO (L2006), and an extra site of care review for commercial members on Signifor LAR (J2502).
15Submit precertification requests at least two weeks before the date of service and include the actual date of service, using the Availity portal or Novologix for specialty drugs.
16Billing team: register applicable molecular tests in DEX and confirm each has its Z-code, then add the Z-code to Medicare MolDX claims in billing system, with no date given by Aetna yet.
17Watch for the next OfficeLink newsletter for the maternity and precertification details.
Codes mentioned
J3490J3590C9399J9999A9699Q5170J2502J9066J9232J9278L2006G0378
Original notice
OfficeLink Updates - November 2026 notices and reminders (PDF)
aetna.com · Always check the source before changing claims.
Related changes
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