Medicare AdvantagePrior AuthHigh impact
OfficeLink Updates - October 2025 notices and reminders (PDF)
Aetna·NJ, NY, PA, WV·Newsletter
Effective date
Jan 1, 2026
We identified it
Jun 19, 2026
Summary
Aetna is implementing multiple policy changes effective January 1, 2026, including new prior authorization requirements for inpatient rehabilitation, skilled nursing, and home health services in select states, plus updates to specialty drug administration policies and compression stocking coverage exclusions.
Action Required
By December 15, 2025: Billing team must update authorization workflows to require pre-approval for inpatient rehabilitation (revenue code 128), skilled nursing levels 1-4, and home health services (codes G0151-G0153, G0155-G0162, G0299-G0300, G0493-G0496) for Medicare Advantage plans in NJ, NY, PA, and WV. Contact EviCore at 1-888-622-7329 or submit requests online. Update billing system to flag compression stocking codes A6530-A6534, A6539, A6545, A6549 as non-covered for commercial plans. Immediately: Use updated lesion excision coding guidance for CPT codes 11400-11471 and 11600-11646 effective November 1, 2025. Claims without proper authorization will be denied.