← Back to list
OfficeLink Updates - January 2026 notices and reminders (PDF)
Act
by Apr 1, 2026
Effective date
Apr 1, 2026
Identified
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.
Get alerts when payers change rules like this one
We check Aetna and other payers every day and email you when a change matches your specialty and state.
Get Aetna alertsPolicy Monitoring is free. No card required.
What to do
by Apr 1, 2026 · 6 steps
01Update billing system to require prior authorization for 12 new specialty drugs (codes J3490, J3590, C9399, J7322).
02Configure system to bundle medication-assisted treatment codes G2067-G2075 when billed within 7 days.
03Update edits to deny CPT 15734 and 49659 when billed with ventral hernia codes for hernias under 10cm.
04Configure 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.
05Immediately begin obtaining prior auth for laminotomy procedure 63032 (effective January 1, 2026).
06Submit all precertification requests at least 2 weeks in advance through Availity portal.
Codes mentioned
J0741J1747J0638J3490J3590C9399G2067G2068G2069G2070G2071G2072G2073G2074G207515734496594959149592495934959449613496144961549616Z53.01Z53.09Z53.1Z53.20Z53.21Z53.29Z53.8Z53.963032J7322
Original notice
OfficeLink Updates - January 2026 notices and reminders (PDF)
aetna.com · Always check the source before changing claims.
Related changes
See all Aetna changes →Abdominoplasty, Suction Lipectomy, and Ventral Hernia Repair (CPB 0211, reviewed 2026-08-18)MediumNo effective date · Medical PolicyAbdominoplasty, Suction Lipectomy, and Ventral Hernia Repair (CPB 0211, reviewed 2026-03-26)MediumNo effective date · Medical PolicyMedication-Assisted Treatment for Opioid Use Disorder (CPB 1104)MediumNo effective date · Medical PolicyMedication-Assisted Treatment for Opioid Use Disorder (CPB 1104, reviewed 12-2026-08)HighNo effective date · Medical PolicyBrowse every Aetna change in the policy list
Related policy hubs
Aetna policiesGastroenterologyOncologyRadiologyOrthopedicsGeneral SurgeryNeurosurgeryCode J0741Code J1747Code J0638Code J3490Code J3590Code C9399Code G2067Code G2068Code G2069Code G2070Code G2071Code G2072Code G2073Code G2074Code G2075Code 15734Code 49659Code 49591Code 49592Code 49593Code 49594Code 49613Code 49614Code 49615Code 49616Code Z53.01Code Z53.09Code Z53.1Code Z53.20Code Z53.21Code Z53.29Code Z53.8Code Z53.9Code 63032Code J7322