Aetna Medicare prior authorization forms and decision times

Aetna’s precertification lists apply to its commercial and Medicare plans alike, and a provider can send a request for an Aetna Medicare Advantage member by EDI, through Aetna’s secure provider website (Availity) or by phone at the number on the member’s ID card, according to Aetna’s precertification overview and its precertification list. Since January 1, 2026, the federal rule CMS-0057-F has required Medicare Advantage plans to decide a standard request for a medical item or service within 7 calendar days and an expedited one within 72 hours, according to the CMS fact sheet on the rule (January 17, 2024).

There is no single Aetna Medicare prior authorization form for medical services. Part B drugs have their own Medicare precertification form, the companies that handle home health reviews for Aetna in some states have their own request forms, and Part D drugs go through a coverage determination request.

At a glance

• Knee arthroscopy and meniscectomy need approval for Medicare Advantage members only.
• Aetna asks for medical-list requests two weeks before the service.
• Medical-list approvals last six months unless eligibility or coverage changes.
• Aetna approved 80.14% to 100% of standard Medicare Advantage requests in 2025, by contract.
• A new Medicare Advantage coordinated care plan can’t require new approval for active treatment for at least 90 days.

Which services need prior authorization on Aetna Medicare plans

Aetna’s participating provider precertification list (updated October 1, 2026) covers Aetna Medicare plans along with its commercial plans, and a few rows differ by plan line. Knee arthroscopy and knee meniscectomy (CPT 29875, 29876, 29877 and 29879) need precertification for Medicare Advantage members only. Hyperbaric oxygen therapy stopped needing prior authorization for Aetna Medicare Advantage members on July 1, 2025, according to Aetna’s 2026 Medicare member list, and the provider list now requires it for commercial members only.

Aetna updates the list each year, usually in January and July. Neurostimulator codes C8007, C8008, C8009, C8011, C8012 and C8013 joined it on July 1, 2026. To check one code, Aetna’s precertification lists page includes a CPT code search.

For a Medicare Advantage member, Aetna bases its coverage decision on CMS policy, including national and local coverage determinations (NCDs and LCDs) where they exist. Where there is none, it uses its own criteria and Clinical Policy Bulletins.

Behavioral health services have a separate behavioral health precertification list, effective August 1, 2024, which also applies to Aetna Medicare plans. It includes inpatient stays, partial hospitalization (with codes G0410 and G0411 for Medicare Advantage members only), residential treatment, applied behavior analysis (ABA) and transcranial magnetic stimulation (TMS). For the rules that apply across Medicare, see the guide to Medicare prior authorization.

Have Silna check which Aetna Medicare services need approval

Aetna Medicare prior authorization forms and where to send them

Silna handles the first three rows below. Part D drugs fall under the pharmacy benefit, outside that work, so the table gives their route only.

Aetna’s precertification line for Medicare plans takes questions about a request at 1-800-624-0756 (TTY: 711).

Aetna also hands some Medicare reviews to outside companies. Its precertification list names them under special programs:

Three home health reviewers use their own request forms. Carelon and EviCore each take a Home Health Care Authorization Request Form by fax, and Tango takes the Tango Authorization Request Form by fax or requests through its provider portal, which only participating providers can use.

For services on its medical list, Aetna’s precertification list says, “You must submit precertification requests at least two weeks in advance.” For commercial plans and Aetna’s appeal steps, see the Aetna prior authorization guide.

How long Aetna Medicare takes to decide

Aetna’s Medicare prior authorization page (updated October 1, 2026) gives these as the times members can usually expect:

The medical-service times are the CMS-0057-F limits, and the Part B drug times are set by 42 CFR 422.572 and 422.568.

Aetna also publishes how it performed. Its 2025 prior authorization metrics, one report for each of its 42 Medicare Advantage contracts, show standard requests for medical items and services approved at rates from 80.14% to 100%. Expedited requests were denied more often than standard ones in 37 of the 40 contracts that reported both. Of the denials that were appealed, between 53.33% and 95.37% were approved on appeal, across the 40 contracts that reported it.

In KFF’s review of insurers’ 2025 reports (August 13, 2026), CVS Health, Aetna’s parent, is among the Medicare Advantage insurers with a median standard response under one day, and CVS denied expedited Medicare Advantage requests at a higher rate than standard ones. In 2024, CVS had the highest share of Medicare Advantage denials appealed of any insurer, at 19.9%, according to KFF (January 28, 2026). Aetna’s own headline figure, from an April 24, 2026 announcement, is that 95%+ of eligible prior authorizations are approved within 24 hours. The announcement doesn’t give a separate figure for Medicare.

When a denial stands, the steps are in the guide to appealing a prior authorization denial.

When an Aetna Medicare approval ends or a patient changes plans

Aetna’s precertification list says an approval is valid for six months if the member’s eligibility and plan coverage for the service haven’t changed, unless the decision says otherwise. A behavioral health approval is valid for the authorized time period.

Medicare’s Open Enrollment Period runs October 15 to December 7, and the new coverage starts January 1. A patient already in a Medicare Advantage plan can switch again from January 1 to March 31, according to Medicare.gov. Under CMS-4201-F, a Medicare Advantage coordinated care plan’s approval for a course of treatment stays valid while the treatment is medically necessary, and a patient mid-treatment who joins a new coordinated care plan gets a transition period of at least 90 days, during which that plan can’t require prior authorization for the treatment.

January is also when plans reset for many patients at the same time. HealthPRO Heritage, a post-acute therapy provider, reported these results for January 2026:

What Silna does with Aetna Medicare requests

For Aetna Medicare Advantage patients, Silna keeps a list of authorizations coming due and renewals ahead of their end dates, so an approval doesn’t lapse partway through treatment. It submits each request and follows up until the payor or its reviewer decides. Its Predictive Document Intelligence reviews each request against the payor’s criteria ahead of submission, and its insurance monitoring picks up a patient’s move to a new plan. All of this work covers medical and behavioral health benefits.

Silna holds G2’s top rating for prior authorization software, 4.8 of 5 across 66 verified reviews.

Use Silna to renew Aetna Medicare approvals before they lapse

Key terms

Precertification

Aetna’s term for prior authorization, the plan’s approval before a listed service is provided.

Part B drug

A drug covered under the medical benefit, usually given in a clinic or doctor’s office.

Coverage determination

A Medicare plan’s decision on whether it will cover a Part D drug.

Delegated review

A prior authorization review that a plan hands to an outside company, such as EviCore or Carelon.

Open Enrollment Period

The yearly window, October 15 to December 7, when people with Medicare can change plans for the next year.

Frequently Asked Questions

Is there an Aetna Medicare prior authorization form?

Not for medical services in general, which go through Availity, EDI or the number on the member’s ID card. The exceptions are Part B drugs, which use form GR-69374-3, and home health in the states where Carelon, EviCore or Tango reviews it. Part D drugs use Aetna’s Request for Medicare Drug Coverage Determination.

How long does Aetna Medicare take to decide a prior authorization?

Up to 7 calendar days for a standard medical request and 72 hours for an expedited one. Aetna usually decides a Part B or Part D drug request within 72 hours, or 24 hours when expedited.

What number do providers call with Aetna Medicare precertification questions?

1-800-624-0756 (TTY: 711). Aetna’s commercial plans use a different line, 1-888-632-3862.

Does Aetna Medicare require prior authorization for behavioral health services?

Yes, for the services on Aetna’s behavioral health precertification list. Codes G0410 and G0411 for partial hospitalization need approval for Medicare Advantage members only.

How long does an Aetna Medicare prior authorization approval last?

Six months for a service on the medical list, as long as the member’s eligibility and coverage don’t change and Aetna sets no other period. Under CMS-4201-F, an approval for a course of treatment lasts until the treatment is no longer medically necessary.

This article is general educational information and does not give medical, legal or insurance advice. Aetna updates its lists and forms during the year, so check the current version before you send a request.

About the author

Jeffrey Morelli

Jeffrey Morelli is the Co-Founder and CEO of Silna Health, the first Care Readiness Platform built to remove the administrative barriers that delay care. Silna automates benefit checks, eligibility, and prior authorizations across 1,000+ payors, and is backed by $27M from Accel and Bain Capital Ventures. Before Silna, Jeff spent a decade in San Francisco building and scaling products for highly regulated industries, including leading go-to-market at Truework (Series C, acquired by Checkr).

Last updated: October 20, 2026.