Aetna Issues New Radiation Therapy Preapproval Requirements

August 2019 ~

As of July 1, Aetna now requires authorization for its enhanced clinical review program with eviCore healthcare for certain outpatient radiation therapy services.

The following procedures will now require prior authorization under Aetna’s Enhanced Clinical Review Program:

  • High-tech outpatient diagnostic imaging procedures such as MRI/MRA, nuclear cardiology, and PET scan and CT scan, including CTA
  • Non-emergent outpatient stress echocardiography
  • Non-emergent outpatient diagnostic left and right heart catheterization
  • Insertion, removal and upgrade of elective implantable cardioverter defibrillator, cardiac resynchronization therapy defibrillator and implantable pacemaker
  • Polysomnography (attended sleep studies)
  • Interventional pain management
  • Musculoskeletal large joint (hip and knee) arthroplasty procedures

The following services do not require preapproval:

  • Inpatient radiology
  • Emergency room radiology
  • Outpatient radiology (other than those services listed above)

For a complete list of procedures requiring an authorization, visit eviCore healthcare.



Source(s): Aetna OfficeLink Updates, June 2019;