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OfficeLink Updates - July 2025 notices and reminders (PDF)
Aetna·Rheumatology, Oncology, Oral & Maxillofacial Surgery +2 more·Newsletter
Effective date
Jun 18, 2025
We identified it
Jun 19, 2026
Summary
Aetna has updated its National Precertification List (NPL) with multiple changes effective June-July 2025, requiring new prior authorization for several specialty drugs (denosumab, ustekinumab, tocilizumab variants) while removing precertification requirements for electric scooters, orthognathic surgery, TMJ procedures, and Medicare hyperbaric oxygen therapy. Additionally, certain oncology immune checkpoint inhibitors will have reduced 90-day initial approval periods when administered in outpatient hospital settings starting October 1, 2025.
Action Required
IMMEDIATE: Update billing system to require prior authorization for denosumab and ustekinumab drugs (codes J3490, J3590, C9399) - denosumab variants effective June 18, ustekinumab variants effective June 23, and Encelto effective July 15. Remove prior auth requirements for electric scooters (E1230), orthognathic surgery (D7296, D7940-D7996), and TMJ procedures (D7830, D7871) effective July 1. For Medicare only, remove prior auth for hyperbaric oxygen therapy (99183, G0277). Submit all precertification requests at least 2 weeks in advance through Availity portal or Novologix for specialty drugs. Update encounter forms and alert providers of these changes to prevent claim denials.