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Procedures, programs, and drugs that require precertification

Procedures, programs, and drugs that require precertification Participating provider precertification list Starting February 1, 2022 Applies to: Aetna plans, except Traditional Choice plans All health benefits and insurance plans offered and/or underwritten by Innovation Health plans, Inc., and Innovation Health Insurance Company, except indemnity plans Foreign Service Benefit Plan, MHBP and Rural Carrier Benefit Plan All health benefits and health insurance plans offered, underwritten and/or administered by the following: Banner Health and Aetna Health Insurance Company and/or Banner Health and Aetna Health Plan Inc.

Artificial intervertebral disc surgery (cervical spine) • Arthrodesis for spine deformity • Cervical laminoplasty • Cervical, lumbar and thoracic laminectomy and\or laminotomy procedures • Kyphectomy* • Laminectomy with rhizotomy • Spinal fusion surgery – precertification required for sacroiliac joint fusion surgery •

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