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AetnaCommercial · Prior Auth · Newsletter · Oncology, Hematology, Rheumatology +3 moreHigh impact

OfficeLink Updates - May 2026 notices and reminders (PDF)

Act
by May 1, 2026
Effective date
May 1, 2026
Identified
Jun 19, 2026

Summary

Aetna has updated their National Precertification List with multiple changes taking effect between May 2026 and January 2027. Several drugs will now require precertification including ustekinumab-srlf, ranibizumab-nuna, and others, while Fulphila will no longer require precertification for Medicare patients.

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What to do

by May 1, 2026 · 5 steps
01Billing team must update precertification requirements in billing system for specified drug codes.
02Stop requiring precertification for Fulphila (Q5108) for Medicare patients.
03Add precertification requirements for ustekinumab-srlf (Q5098), ranibizumab-nuna (Q5124), and other listed drugs with their respective J-codes.
04Update staff workflow to submit precertification requests at least two weeks in advance through Availity portal.
05Claims will be denied without proper precertification.

Codes mentioned

Q5108Q5098Q5124J3490J3590C9399Q5135Q5112Q5151J1756J2916J9301J92173648236483J9205

Original notice

OfficeLink Updates - May 2026 notices and reminders (PDF)
aetna.com · Always check the source before changing claims.
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Related changes

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Related policy hubs

Aetna policiesOncologyHematologyRheumatologyOphthalmologyNephrologyVascular SurgeryCode Q5108Code Q5098Code Q5124Code J3490Code J3590Code C9399Code Q5135Code Q5112Code Q5151Code J1756Code J2916Code J9301Code J9217Code 36482Code 36483Code J9205

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