CommercialPrior AuthHigh impact
OfficeLink Updates - February 2025 notices and reminders (PDF)
Aetna·Orthopedics, Pulmonology, Oncology +1 more·Newsletter
Effective date
Feb 1, 2025
We identified it
Jun 19, 2026
Summary
Aetna is implementing multiple billing changes including new precertification requirements for several drugs and procedures, eliminating facility fee reimbursement for hospital-owned practices when physician fees are already paid, and requiring adherence documentation codes for CPAP supplies.
Action Required
By February 1, 2025: Update prior authorization system to require precertification for Tecentriq Hybreza, Ocrevus Zunovo, Boruzu, and Tremfya (codes J3490, J3590, C9399, J9999) and Medicare knee arthroscopy procedures (29875-29877, 29879) and Lupron depot (J1950). Remove precertification requirement for embryo thawing (89352). By February 26, 2025: Add precertification for Aucatzyl and Kebilidi. By April 1, 2025: Update CPAP billing to require adherence codes G8851, G8854, G8855 on claims or reimbursement will be denied. By June 1, 2025: Hospital-owned practices must review billing to prevent duplicate facility and physician fee submissions for commercial plans.