Who is affected by this change?

This affects Aetna Dermatology, General Surgery, Plastic Surgery, Orthopedics, Oncology providers on Medicare Advantage, Commercial plans.

When does this change take effect?

This change is effective Aug 1, 2025.

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AetnaMedicare Advantage · Prior Auth · Newsletter · Dermatology, General Surgery, Plastic Surgery +2 moreHigh impact

OfficeLink Updates - August 2025 notices and reminders (PDF)

Q: What do I need to do?

By August 1, 2025: Billing team must update precertification system to require prior authorization for Conexxence, Bomyntra, Omlyclo, and other listed specialty drugs with codes J3490, J3590, C9399. By November 1, 2025: Update billing rules to use codes 11400-11471 and 11600-11646 only for cutaneous/superficial subcutaneous lesions, and codes 21011-28045 for deep subfascial/submuscular lesions. By November 15, 2025: Prepare for new Medicare inpatient payment structure - claims for 1+ midnight stays will be paid at observation rates initially with appeal rights for full inpatient rates.

Q: Which billing codes are affected?

The following codes are affected: 11400, 11401, 11402, 11403, 11404, 11405, 11406, 11420, 11421, 11422, 11423, 11424, 11426, 11440, 11441, 11442, 11443, 11444, 11446, 11450, 11451, 11462, 11463, 11470, 11471, 11600, 11601, 11602, 11603, 11604, 11606, 11620, 11621, 11622, 11623, 11624, 11626, 11640, 11641, 11642, 11643, 11644, 11646, 21011, 21012, 21013, 21014, 21552, 21554, 21555, 21556, 21930, 21931, 21932, 21933, 22900, 22901, 22902, 22903, 23071, 23073, 23075, 23076, 24071, 24073, 24075, 24076, 25071, 25073, 25075, 25076, 26113, 26116, 27043, 27045, 27047, 27048, 27327, 27328, 27337, 27339, 27618, 27619, 27632, 27634, 28039, 28041, 28043, 28045, J3490, J3590, C9399.

Act

by Aug 1, 2025

Effective date

Aug 1, 2025

Identified

Jun 19, 2026

Summary

Aetna is implementing three major changes: a new payment structure for Medicare inpatient stays 1+ midnight that pays faster at observation rates with appeal rights, new CPT code requirements for lesion excisions based on tissue depth, and expanded precertification requirements for multiple specialty drugs including biosimilars.

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What to do

by Aug 1, 2025 · 3 steps

01Billing team must update precertification system to require prior authorization for Conexxence, Bomyntra, Omlyclo, and other listed specialty drugs with codes J3490, J3590, C9399.

02By November 1, 2025: Update billing rules to use codes 11400-11471 and 11600-11646 only for cutaneous/superficial subcutaneous lesions, and codes 21011-28045 for deep subfascial/submuscular lesions.

03By November 15, 2025: Prepare for new Medicare inpatient payment structure - claims for 1+ midnight stays will be paid at observation rates initially with appeal rights for full inpatient rates.

Codes mentioned

1140011401114021140311404114051140611420114211142211423114241142611440114411144211443114441144611450114511146211463114701147111600116011160211603116041160611620116211162211623116241162611640116411164211643116441164621011210122101321014215522155421555215562193021931219322193322900229012290222903230712307323075230762407124073240752407625071250732507525076261132611627043270452704727048273272732827337273392761827619276322763428039280412804328045J3490J3590C9399

Original notice

OfficeLink Updates - August 2025 notices and reminders (PDF)

aetna.com · Always check the source before changing claims.

View original ↗

Related changes

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Related policy hubs

Aetna policies Dermatology General Surgery Plastic Surgery Orthopedics Oncology Code 11400 Code 11401 Code 11402 Code 11403 Code 11404 Code 11405 Code 11406 Code 11420 Code 11421 Code 11422 Code 11423 Code 11424 Code 11426 Code 11440 Code 11441 Code 11442 Code 11443 Code 11444 Code 11446 Code 11450 Code 11451 Code 11462 Code 11463 Code 11470 Code 11471 Code 11600 Code 11601 Code 11602 Code 11603 Code 11604 Code 11606 Code 11620 Code 11621 Code 11622 Code 11623 Code 11624 Code 11626 Code 11640 Code 11641 Code 11642 Code 11643 Code 11644 Code 11646 Code 21011 Code 21012 Code 21013 Code 21014 Code 21552 Code 21554 Code 21555 Code 21556 Code 21930 Code 21931 Code 21932 Code 21933 Code 22900 Code 22901 Code 22902 Code 22903 Code 23071 Code 23073 Code 23075 Code 23076 Code 24071 Code 24073 Code 24075 Code 24076 Code 25071 Code 25073 Code 25075 Code 25076 Code 26113 Code 26116 Code 27043 Code 27045 Code 27047 Code 27048 Code 27327 Code 27328 Code 27337 Code 27339 Code 27618 Code 27619 Code 27632 Code 27634 Code 28039 Code 28041 Code 28043 Code 28045 Code J3490 Code J3590 Code C9399

OfficeLink Updates - August 2025 notices and reminders (PDF)

Summary

Get alerts when payers change rules like this one

What to do

Codes mentioned

Original notice

Related changes

Related policy hubs

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