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OfficeLink Updates - January 2026 notices and reminders (PDF)
Aetna·Orthopedics, Neurosurgery, Oncology +4 more·Newsletter
Effective date
Apr 1, 2026
We identified it
Jun 19, 2026
Summary
Aetna is implementing multiple policy changes effective April 1, 2026, including new prior authorization requirements for specialty drugs and procedures, bundling of medication-assisted treatment services, updated coding rules for ventral hernias, and new modifier requirements for reduced/discontinued services.
Action Required
By April 1, 2026: Update billing system to require prior authorization for 12 new specialty drugs (codes J3490, J3590, C9399, J7322). Configure system to bundle medication-assisted treatment codes G2067-G2075 when billed within 7 days. Update edits to deny CPT 15734 and 49659 when billed with ventral hernia codes for hernias under 10cm. Configure system to require modifiers 52, 53, 73, or 74 for radiology, diagnostic, lab, or surgery services with ICD-10 codes Z53.01, Z53.09, Z53.1, Z53.20, Z53.21, Z53.29, Z53.8, Z53.9. Immediately begin obtaining prior auth for laminotomy procedure 63032 (effective January 1, 2026). Submit all precertification requests at least 2 weeks in advance through Availity portal.